What is Early Intervention?
Early Intervention or Birth to Three programs are designed to serve children with developmental delays as well as those who are at risk for developmental delays. Services differ depending on the state in which they are provided however generally include physical therapy, occupational therapy, and speech language pathology, and emphasise physical, cognitive, communication, social/emotional, and self help skills. Other services that may be included are Infant Education, as well as Social Work based services.
What makes Early Intervention different from other paediatric therapy intervention?
Early intervention differs from other paediatric therapy models for a variety of reasons including the timing of the intervention, the model or manner in which it is provided, as well as the environment in which intervention takes place.
Timing: Why Early Intervention?
As stated above, Early Intervention Services are designed to serve children birth to three years of age. The foundation of Early Intervention lies in the idea that children are born primed to learn. The brain, much like other structures in the body, is not fully developed at birth. And while the brain is not fully developed until much later in life, we understand through research that the majority of learning and development occurs in the first 2-3 years of life. Therefore, the earlier in a child’s life that we are able to intervene, the more affect we can have on their learning and brain formation, and the better the outcomes.
Neuroplasticity: The How of Learning?
In order to better understand how this learning occurs and how we can affect it, it is important that we have a basic understanding of the neuroanatomy of learning. Below I have provided a very rudimentary description of this complex process.
Learning in children occurs through a complex sequence in which fired neurons, through electrical and chemical interactions, form neural pathways within the brain. Essentially the brain learns how to take in information, process it, and produce the appropriate response. These pathways are then strengthened through use. Much like habits, the more utilised these neural pathways are, the stronger the neurological connections become. Conversely, those that we don’t use as frequently become weaker, and are often shed, or die-off in a process colloquially referred to as neural pruning.
In children with developmental delays, both congenital or acquired, a child often suffers from maladaptive or insufficient neurological processing. In essence, the brain is not appropriately processing input in order to produce appropriate output. This can result in a variety of impairments including sensory, motor, or speech deficits. In brief, the neurological pathways that I described before are either not formed, or are formed incorrectly.
When addressed early, a therapist, through the use of repetition and specifically designed techniques, can help to “re-wire” or “re-write” a child’s neurological pathways in order to promote appropriate development or growth. This process, the ability of the brain to change or adapt in response to experience, is known as Neural Plasticity. While not exclusive to young children, we know through research that Neural Plasticity is greatest in the first few years of life, when the brain has not finished developing.
Family Centered Approach to Therapy Services
The second part of early intervention, and one that I find as important if not more important that the physiological reasons supporting Early Intervention Services is the manner in which intervention is performed.
Early Intervention or Birth to Three therapeutic models differ from hospital based medical models as they emphasise a home based coaching mode of intervention. Which means services are most often provided in the home (*see environment), with a parent or guardian present. The therapist has as much responsibility to work with the child as they do to coach the child’s caregiver on the methods and techniques they are using. The reasoning behind this lies in the theme of repetition. As we discussed above, neural pathways are formed and broken as a result of their use. This means that those actions that are performed the most will have the strongest neural pathways while the ones that are only performed on occasion or when the therapist is present, will fade away. This also means that poorly executed or compensatory patterns repeated daily will hold stronger and be more difficult to break. As I always tell parents, ‘What a therapist does 1-2 hours a week means very little, but what you and the child do every day, multiple times a day, that’s what will stay’.
Where: The Importance Behind Utilising a Child's Natural Environment.
Lastly, lets talk about the environment. Research shows that children learn best when intervention is provided in their natural environment. This could be their home, school, daycare, grandma’s house, or the playground. If you live in a city this could include the city streets, public libraries, playgrounds, or subways. If you are like me and live on an island it could include the beach, the ocean, hiking trails, or the docks. Wherever your child goes, this is where we should treat. Where they struggle most is where we should start. When we teach children in their natural environment we can make meaningful functional progress. We find their limitations and address them directly giving them greater access to their surroundings. We turn their home into a therapy gym, so every activity or routine task is one more opportunity to practice, one more repetition in the learning process.
The Who
All children! All children, no matter where they live, who their parents are, or what their financial status is should have access to Early Intervention Services. If we address a child’s needs earlier in life, we significantly increase the ability of the child to integrate and participate in future settings, including school, community, and ultimately employment.
The Take-Away
When we talk about early intervention services it’s important to note that the emphasis is always and should always be on the child and their family. Learning should be done early, in order to capitalise on a child’s natural developmental curve. It should occur in their natural environment to target activities and tasks that are meaningful to them while also allowing them the opportunity for unlimited practice. And lastly, it should be facilitated by those that they love and trust. If done correctly, the therapist should appear as a silent force, the conductor to the symphony that the child is playing.
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