Early Intervention Practices Around the World (International Issues in Early Intervention) (ISEI)

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Samuel L. Odom is Director of the Frank Porter Graham (FPG) Child Development Institute and Professor of Education at The University of North Carolina at Chapel Hill. Prior to his work at The University of North Carolina at Chapel Hill, Dr. Odom previously served in faculty positions at Indiana University and Peabody College/Vanderbilt University. Dr. Odom received a master's degree in special education in 1976 and an educational specialist degree in educational psychology from the University of Tennessee at Knoxville in 1979. He earned his doctorate in 1982 in education and human development from the University of Washington.

Throughout his career, Dr. Odom has held positions as a preschool teacher, student teaching supervisor, program coordinator, teacher educator, and researcher. He has written many articles and chapters about programs for young children and their families and has served as the co-editor of five books on early childhood special education. Dr. Odom is an associate editor for Exceptional Children and is on the editorial board of Journal of Early Intervention, Topics in Early Childhood Special Education, Journal of Autism and Developmental Disabilities, and Early Childhood Research Quarterly. He received the Special Education Outstanding Research Award from the American Educational Research Association Special Education Special Interest Group in 1999, the Merle Karnes Contribution to the Field Award from the Division for Early Childhood of the Council for Exceptional Children (CEC) in 2001, and the Outstanding Special Education Research Award from CEC in 2007.

Dr. Odom's research interests include interventions and teaching approaches that promote social competence of young children, effective intervention approaches for children with autism, and early childhood curricula that promote children's school success.

Marci J. Hanson, Ph.D., is Professor in the Department of Special Education at San Francisco State University (SFSU). At SFSU, Dr. Hanson is actively engaged in teaching, research, and service related to young children and their families. In addition to these responsibilities, she directs the SFSU joint doctoral program in special education with the University of California, Berkeley, and codirects the early childhood special education graduate program. She is a consultant with the child and adolescent development faculty of the Marian Wright Edelman Institute for the Study of Children, Youth, and Families at SFSU and with San Francisco Head Start.

James A. Blackman, M.D., M.P.H., is Professor of Pediatrics and Director of Research at the Kluge Children's Rehabilitation Center at Children's Medical Center at the University of Virginia. Dr. Blackman has been very involved in the study, implementation, and educational aspects of early intervention services through interdisciplinary collaborations at the local, state, and national levels, In 1988, he founded Infants and Young Children, an interdisciplinary journal on special care practices. Dr. Blackman has authored or edited numerous books on early intervention, including Medical Aspects of Developmental Disabilities in Children Birth to Three (Aspen Publishers, 1997). He received a doctoral degree in medicine from The Ohio State University and received fellowship training in developmental pediatrics at Harvard University. As a 1998–1999 recipient of the Mary E. Switzer Fellowship, sponsored by the U.S. Department of Education's National Institute on Disability and Rehabilitation Research, Dr. Blackman studied early intervention practices in Europe.

Sudha Kaul, Ph.D., is Executive Director at the Indian Institute of Cerebral Palsy. Dr. Kaul received a doctoral degree in augmentative and alternative communication (AAC) from Manchester Metropolitan University in the United Kingdom. She has worked as a classroom teacher and teacher trainer. In addition to serving as Executive Director of the Indian Institute of Cerebral Palsy, Dr. Kaul is the Institute's Founder Vice Chairperson. She also serves as Director of the Post Graduate Diploma Course in Special Education at Jadavpur University in Calcutta. Dr. Kaul developed a test in receptive language of Hindi-speaking children, co-authored a book on AAC, and has developed various video teaching programs on early intervention. In 1990, she received the President's Award from the International Society for Augmentative and Alternative Communication (ISAAC) and is the Indian representative on ISAAC's board of directors. Her research focuses on child language and the communication interaction patterns of typically developing children and children who do not speak.

Michael J. Guralnick, Ph.D., is Director of the Center on Human Development and Disability (CHDD) and Professor of Psychology and Pediatrics at the University of Washington, Seattle. Comprising both a University Affiliated Program and a Mental Retardation and Developmental Disabilities Research Center, the CHDD is one of the largest interdisciplinary research and training centers in the United States, addressing issues directly related to developmental disabilities. More than 600 faculty and staff members and doctoral and postdoctoral students operate within the four CHDD buildings on the campus of the University of Washington and in community sites to conduct basic and applied research, to provide clinical services to individuals and their families, to provide interdisciplinary clinical and research training, and to provide technical assistance and outreach training to practitioners and community agencies.

Dr. Guralnick has directed research and development projects in the fields of early childhood intervention, inclusion, peer relationships, and pediatric education. He has published more than 100 articles and book chapters and 7 edited volumes. Dr. Guralnick's publications have appeared in a diverse group of well-respected journals, including Child Development, Pediatrics, American Journal on Mental Retardation, Journal of Early Intervention, Developmental Psychology, Journal of Developmental and Behavioral Pediatrics, Journal of Applied Developmental Psychology, and Development and Psychopathology.

He currently directs a major research project supported by the National Institute of Child Health and Human Development designed to determine the effectiveness of a comprehensive early intervention program in promoting the peer-related social competence of young children with developmental delays.

Dr. Guralnick received the 1994 Research Award from the American Association on Mental Retardation and the 1997 Distinguished Research Award from The Arc of the United States. He is past President of both the American Association of University Affiliated Programs and the Council for Exceptional Children's Division for Early Childhood and is former Chair of the Mental Retardation and Developmental Disabilities Research Center Directors. He is currently Chair of the International Society on Early Intervention and is President-Elect of the Academy on Mental Retardation.

Excerpt. Reprinted by permission. All rights reserved.:

From Chapter 1 in Early Intervention Practices Around the World
Edited by Samuel L. Odom, Ph.D., Marci J. Hanson, Ph.D., James A. Blackman, M.D., M.P.H. and Sudha Kaul, Ph.D.
©2003. Brookes Publishing. All Rights Reserved.

Early Intervention: An Overview

BIOLOGICAL RATIONALE FOR EARLY INTERVENTION

Regardless of the mixed results in evaluating early intervention efficacy and effectiveness, there are biological reasons why an intervention, if properly timed and implemented, can substantially improve the developmental outcome of a particular child. Much has been learned since the early 1990s about how the brain develops, both structurally and organizationally, during fetal and early postnatal life. By the end of the second year of life, the brain has achieved four fifths of its adult weight and size. Obviously, the brain grows at a remarkable pace from conception through the first several years of life. This begins with five critical phases of prenatal brain development. The first phase is neural proliferation. By the fifth prenatal month, all of the neurons that the brain will ever have—approximately 100 billion—are created. In the second phase, neural migration, neurons begin to migrate to the outer cortex of the brain. This delicate process is completed by the end of the sixth prenatal month. These events create the basic "hardware and wiring" necessary for sensory input, information processing, and motor output. The third phase involves a process called synaptogenesis, by which the neurons develop interconnections (or synapses) that allow them to communicate with one another. More synapses are created than are really necessary. Thus, "pruning" occurs during the fourth phase, reducing the number of connections so that only those that are used and needed survive. In the fifth phase, the nerves are coated with myelin, a fatty sheath that accelerates the transmission time for electrical impulses, especially along the nerves that run from the brain down the spinal cord. The result is that commands are executed almost instantaneously. Primitive and survival-related cognitive structures are myelinated first during early postnatal life. Executive functioning structures are myelinated as late as adolescence and early adulthood. This information alone could justify early intervention, although it is still necessary to find the best way to facilitate typical brain development during critical periods, minimize the impact of injury, and take advantage of the brain's attempts to self-repair (Shonkoff & Phillips, 2000).

Critical Periods of Brain Development

In the 1990s, research on early learning and its relationship to brain development exploded. During this time, President Clinton designated the 1990s as the "Decade of the Brain" in the United States. Discoveries were made not only in how readily newborns can learn but also in how much they already know at birth. For example, Dr. Patricia Kuhl at the University of Washington has demonstrated that the brains of newborns are prewired to recognize every sound in every human language. They lose this capacity over the first year of life, maintaining recognition only for those sounds to which they are exposed. For example, Japanese infants distinguish between l and r at birth. By 9 months of age, they lose this ability (Kuhl et al., 1992).

Perhaps there are certain critical times for learning. It is known that infants who are deprived of early visual experience will permanently lose vision. In animal experiments, such deprivation results in significant deterioration of the connections between nerve cells in the visual cortex (Hubel & Wiesel, 1970). Once these connections are lost, they do not repair themselves. Similarly, there may be certain aspects of language for which the brain is prepared to acquire given the appropriate stimulation. If the stimulation is not present, those aspects (e.g., sound recognition) are lost. Bruer and Greenough (2001) referred to this phenomenon as "experience expectant." Basically, it comes down to "use or lose it!" For some functions, infants seem to have built-in capacities that need to be exercised in order to be preserved.

Fortunately, the capacity to learn is lifelong, although infants and toddlers do have the edge when it comes to speed. Young children clearly are more adept at learning new languages than adolescents or adults. Of course, foreign language curricula do not reflect this well-demonstrated fact. Foreign language training rarely begins before middle school, often not before high school. Bruer and Greenough (2001) referred to this type of learning as "experience dependent." Without certain experiences, one simply cannot learn certain things. One cannot learn what snowflakes feel like on the face unless one has been outside while it is snowing. Similarly, an infant with spina bifida may not learn shape and size relationships because he or she cannot get into the kitchen cupboards to play with pots and pans.

Injury and Self-Repair

The amazing processes of brain development unfold in a prescribed, organized manner unless there is a disrupting influence, such as chromosome microdeletion (e.g., Prader-Willi syndrome), intrauterine infection (e.g., cytomegalovirus, rubella), hazardous chemical exposure (e.g., alcohol), or trauma (e.g., birth asphyxia). Even with these unfortunate events, there is evidence that the brain attempts to self-correct. In contrast to the adult brain, the developing brain initially develops redundant neurons that act as a neurological reserve against possible injury (Sarnat, 1996).

According to Farel and Hooper (1995), for this "plasticity" to be operative following injury, new neurons must be created or intact regions must compensate. Although advances are being made in the area of regeneration, this mode of recovery is quite limited. As noted previously, the absolute number of neurons and their migration to various areas of the brain is completed by the second trimester of gestation. Yet, research suggests that in a few areas of the brain (e.g., the hippocampus), new neurons are added, even in adulthood. The problem is that even if there were a way to replace lost neurons (and there may well be in the future), they would have to find their appropriate positions in the nervous system and reconnect with the complicated network of other neurons. Intense work at the basic scientific level may make this approach feasible someday.

Compensation may be possible but effective only during critical periods of brain development and only within certain biological limits. That is, neurons in the occipital cortex programmed to interpret visual images cannot take over for damaged neurons in the temporal cortex responsible for auditory comprehension. Stimulation enhances new neuronal connections, hemispheric dominance is changeable, and different areas of the brain can be used for the same task.

Figure 1.3 demonstrates the brain's capacity to self-repair. The left panel of the figure shows the computed tomography (CT) scan of a 4-month-old who sustained traumatic brain injury from child abuse. The CT scan shows diffuse and severe destruction of brain tissue. Examination of the child 1 month after injury suggested that she would likely have cerebral palsy and mental retardation. The chapter author conducted a developmental and neurological examination of the child at 1 year of age (see right panel of Figure 1.3), however, and the findings were completely normal. Despite the obvious damage shown on the CT scan, the child's brain was able to adapt and compensate for the injury. Although such a complete and unexpected recovery does not occur in all cases of traumatic brain injury in infancy and early childhood, this example illustrates the potential of plasticity even when the specific factors that facilitate such a dramatic improvement are not known.

Inconsistent results from studies of various interventions for children with specific disabilities or risk factors indicate that it is not yet known how to capitalize fully on the brain's plasticity and potential for recovery. The most obvious options are interventions that facilitate nature's determination to get it right the first time or to mitigate the effects of injury. When the disrupting influence was not prevented, secondary preventive efforts can minimize further neurological deficits. Say that a mother did not take folic acid at the time of conception and her child developed spina bifida. Facilitation of the child's mobility will foster the development of new synapses because of increased opportunities for learning in an expanded environment. In other words, doing nothing else in early intervention beyond removing barriers to typical brain development processes may be the most important and effective intervention. Perhaps no complex or expensive training programs are needed. Simply thinking about typical developmental processes and how these might be facilitated through interventions with the child, the family, and the environment almost guarantees effectiveness.

FROM SKILL MASTERY TO SOCIAL COMPETENCE

In the early intervention field, there has been a major philosophical shift away from focusing merely on acquisition and practice of developmental skills to developing functional and social competence. Zigler (2000) criticized those who base their (often disappointingly negative) evaluations of early intervention on programs' ability to raise IQ points. He encouraged colleagues in the early childhood education field to look beyond the narrow cognitive focus to the broader basis of human functioning in society—the cluster of skills that make up the construct of social competence.

Early intervention programs that succeed in achieving long-term benefits are typically broad based and have strong parental participation. In studies of early intervention or preschool enrichment programs with comparison groups, motor and cognitive gains are transient. The persistent benefits of these programs seem to be in the social realm: reduced school drop-out, crime, and teen pregnancy rates. Despite this philosophical shift, the bulk of early intervention services still tends to address cognitive and motor issues for three reasons.

First, they are easier to recognize. Second, early childhood specialists have received more training for dealing with them than with other issues. Finally, health and education funding agencies often are more likely to pay for their treatment than for the treatment of social and emotional aspects. No one would suggest that cognitive and motor problems should not be addressed. Rather, it is suggested that they be addressed with the goal of optimizing emotional and social competence in the context of the family.

CONCLUSION: LINKING NEURONS TO PEOPLE AND COMMUNITIES

Scientific advances have increased understanding of how the brain develops, what can impede typical brain development, and which approaches have the potential to help the brain recover. Still, many children who fail to achieve their full potential do so not because of a faulty brain but because of the environment in which their brain develops. Thus, although early intervention works with one child at a time, the greatest challenges lie with the family, community, nation, and world in which the child lives.

The Committee on Integrating the Science of Early Childhood

Development of the U.S. National Research Council and Institute of Medicine published an extensive report on scientific knowledge about the nature of early development (Shonkoff & Phillips, 2000). It sought to understand how early experience affects all aspects of development—from the neural circuitry of the maturing brain, to the expanding network of a child's social relationships, to both the enduring and the changing cultural values of the society in which families raise children. It examined the typical trajectories of early childhood, as well as the atypical developmental pathway that characterizes the adaptations of children with disabilities. The major findings of this report (pp. 386–403) include the following:

  • All children are born wired for feelings and ready to learn.
  • Early environments matter, and nurturing relationships are essential.
  • Society is changing, and the needs of young children are not being addressed.
  • Interactions among early childhood science, policy, and practice are problematic and demand dramatic rethinking.
The Committee's concluding charge to society was to blend the skepticism of a scientist, the passions of an advocate, the pragmatism of a policy maker, the creativity of a practitioner, and the devotion of a parent. The use of such knowledge will ensure both a decent quality of life for all children and a productive future for the world. As the proverb "a stitch in time saves nine" implies, intervention begun early for developmental problems has the greatest chance of preventing more serious problems later on.

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