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PubMed1993

Early intervention in schizophrenia.

The management of schizophrenia may be characterised by two paradigms. The first approaches the schizophrenias as episodic relapsing disorders, where treatment is provided through both acute (crisis) care and to achieve prophylaxis. The second paradigm, sometimes arising from a failure of the first, is of "rehabilitation", involving amelioration of disabilities, occasionally within a framework of relative asylum. We would propose a third paradigm of "early intervention", involving a combination of medical and psychosocial interventions targeted at young, vulnerable people with the aim of preventing or limiting likely social, psychological and mental deterioration. Vigorous intervention early in the course of illness, early recognition and treatment of relapse and the promotion of psychological adjustment to psychotic illness are proposed as key elements of this third paradigm.

Acute Disease↗

PubMed2006

[The prenatal diagnosis and early intervention of nonsyndromic hearing loss of connexin26 gene].

OBJECTIVE: To detect the mutations of gene connexin26 in the pedigrees of nonsyndromic hearing loss, and to make prenatal diagnosis and carry out early intervention to the pedigrees with mutations of gene con nexin26. METHOD: The connexin26 gene of probands in 100 nonsyndromic hearing loss pedigrees was inspected by polymerase chain reaction, single strand conformational polymorphism and direct sequencing to detect the gene mutations. To the pregnant women in pedigrees with confirmed nosogenetic mutations of connexin26 gene, the prenatal diagnosis to the fetus by cordocentesis was made and the early intervention was carried out. RESULT: The homozygous deletion C at position 233-235 of connexin26 cDNA was proved to be a nosogenetic mutation, and G79A, G109A, A341G, G442A, G506A and T608C were proved to be polymorphisms. In the prenatal diagnosis for the second pregnancy of a woman in a pedigree with the homozygous deletion C at position 233-235 of connexin26 cDNA, the same mutation in the fetus' connexin26 gene was found and she was advised to end the pregnancy. CONCLUSION: The homozygous deletion C at position 233-235 of connexin26 cDNA will induce autosomal recessive nonsyndromic hereditary hearing loss and the heterogeneous mutation will not cause hearing loss. The prenatal diagnosis and early intervention can prevent the birth of deaf children. This is the first time in our country to make prenatal diagnosis and proceed early intervention to the fetus of hereditary hearing loss.

Connexin 26↗

PubMed2005

["Early" diagnosis and "early" intervention in children with mental retardation--when is early enough to diagnose them?].

Patients with mental retardation (MR) cannot always be diagnosed accurately by physicians who are specialized in child neurology and/or developmental disorders at their first visit to the clinic. Precise examination such as psychological tests and chromosomal analysis are often necessary to diagnose them. Some patients with autistic disorders without MR often are misdiagnosed as having MR. Patients with mild to moderate MR are sometimes diagnosed late in their late teens or twenties. Timely diagnosis and timely/continuous intervention is more important than early diagnosis and early intervention for the mentally retarded.

Adult↗

PubMed1996

[Early intervention for very-low-birth-weight infant].

In order to establish an early intervention (EI) system for very-low-birth-weight infants, we designed a randomized trial at multiple institutions in Japan. We also reviewed the concept and history of early intervention in USA. Eight medical institutions in different locations were selected for participation. Sixty-two EI group patients and 48 controls without neurological abnormalities (age 2 years) were selected for study. The developmental quotient (DQ) by the revised Kyoto-K method and 15 questionnaire items were monitored twice, at the age of 2 and after one year of EI (3 years). Improvements in behavioral problems, circadian rhythm, and speech were significantly greater in the EI group than in the control group. (P < 0.01). Data on all patients are being collected, and further evaluation and analysis of DQ are planned. The most effective EI method in each specific location and the financial support of its official institutions are required for the success of the EI program for very-low-birth-weight infants.

Early Intervention, Educational↗

PubMedDate not supplied

Cost-effectiveness of early intervention: comparison between intraluminal bronchoscopic treatment and surgical resection for T1N0 lung cancer patients.

BACKGROUND: For patients with early-stage lung cancer (ESLC) and severe comorbidities, the cost-effectiveness of early intervention may be reduced by screening and treatment-related morbidity and mortality in addition to the risk for non-cancer-related deaths. OBJECTIVES: The use of bronchoscopic treatment (BT) for centrally located ESLC as minimally invasive technique has raised questions whether this approach will be more cost-effective than standard surgical resection in the above-mentioned cohort of patients. METHODS: The cost-effectiveness of BT of 32 medically inoperable patients with intraluminal tumor has been compared to a matched control group of surgically treated stage IA cancer patients. RESULTS: Median follow-up after BT for ESLC has been 5 years (range 2-10) versus 6.7 years (range 2-10) for the surgical group. Five patients (16%) developed subsequent primaries/local recurrences after BT versus 4 (12.5%) in the surgical group. The respective percentages of actual survival during follow-up have been 50 and 41%, non-lung-cancer-related death 22 and 31% and lung-cancer-related death 28% in both groups, respectively. So far, the average costs per individual for early management by BT have been Euro 22,638 by surgery, and total expenses have been Euro 209,492 and Euro 724,403, respectively. CONCLUSIONS: Despite the worse initial health status of patients treated with BT, actual survival rates and costs for early intervention underscore the superior cost-effectiveness of BT as early intervention in properly selected individuals with ESLC in the central airways.

Aged↗

PubMed1989

Early intervention for vulnerable infants and their families: an emerging agenda.

Early childhood development is a complex dynamic process that begins at birth and unfolds in a transactional manner as infants interact with their environment. Children are highly adaptive organisms with powerful homeostatic mechanisms; consequently, most high-risk infants do well. Environmental factors are powerful mediators in this process, and a supportive and responsive environment may alleviate many early developmental insults, while a deficient environment can exacerbate developmental weaknesses. Available data suggest that appropriately designed early intervention services can be effective in facilitating both child and family adaptation for a variety of target groups. However, many important questions remain unanswered. For example, although interventions have been shown to improve cognitive function, effects in other important areas such as social and emotional functioning and family coping have not been well studied. Information about the impact of family variables is also incomplete as is our knowledge about which services work best for which children and families. Finally, the influence of protective factors in the child and in the environment requires further exploration. The perinatologist can make several critical contributions to the comprehensive care of high risk infants beyond their medical management. He or she can play a pivotal role in identifying those neonates who need early intervention on the basis of their biologic vulnerability, their environmental risk factors, or both. Perinatologists are also in the best position to facilitate early entry into an appropriate service system and can be important collaborators in providing comprehensive services and long-term follow-up.(ABSTRACT TRUNCATED AT 250 WORDS)

Child Health Services↗

PubMed1994

Early intervention for preschoolers with developmental delays: the case for increased child collaboration.

In this article are analyzed the four following premises that explain why early intervention programs for preschool children with mental retardation (and other disabilities) have tended to adopt a teacher-directed "cultural transmission" or remedial model of education, whereas preschool programs for children without disabilities have generally preferred a more child-directed "developmental" model. (1) The purpose of early intervention is to accelerate and remediate, rather than support, cognitive growth. (2) Learning and accountability are maximized by specific instructional objectives written into educational plans rather than by encouraging children's own constructivist efforts. (3) Children with retardation are defective, not just slow but otherwise normal and so require extensive adult direction. (4) Research findings are favorable rather than ambiguous towards demonstrating the effectiveness of existing instructional methods. The four premises are reviewed and critiqued. It is concluded that there is sufficient doubt about the cultural transmission remedial model to justify further expansion of the developmental approach in early intervention programs, at least for some children in some areas. Changes in attitudes and practices that such an expansion would entail are discussed.

Child, Preschool↗

PubMed1998

Effectiveness of early intervention for vulnerable children: a developmental perspective.

An analysis of the current state of our knowledge of the effectiveness of early intervention for children at risk and for those with established disabilities was provided. A model focused on children's cognitive development was presented in which early intervention is placed firmly within a developmental framework. Both short- and long-term effects, the mechanisms through which early intervention exerts its influence, the relation between those mechanisms and the organization of existing service systems, current limits of programs, and prospects for future research were considered in this model.

Child↗

PubMed1992

A national survey of educational preparation programs for early intervention specialists.

To examine the status of preprofessional education in early intervention, we conducted a nationwide survey of college and university programs offering degrees in education of the deaf. Curriculum content and practicum experiences with infants and toddlers and their families were examined, as well as general comments and recommendations of program directors. Additional information was sought from programs offering specializations at the preschool level to determine whether they had CED affiliation, and if so, whether they were certified in the areas of parent-infant education or early childhood education. The findings are discussed in the context of Public Law 99-457 and the growing emphasis on family centered early intervention.

Adult↗

PubMed1982

A review and analysis of the effectiveness of early intervention programs.

A review was made of 27 studies describing early intervention for biologically impaired infants and young children. Although every study provided some type of documentation of outcome, most studies failed to meet common criteria for scientific research, such as specification of inclusion criteria, documentation of reliability, random assignment, and/or the use of control/contrast groups. Studies were grouped into four classifications on the basis of experimental design as follows: retrospective, prospective-no control group, prospective-control/contrast group, and prospective-random group assignment. A comparative analysis was made of the effectiveness of findings on the basis of statistical evidence and clinical support. Statistical procedures were used in 59% of the studies and statistical support for the effectiveness of early intervention was reported in 48% of the studies. Effectiveness on the basis of subjective, clinical conclusions was reported in 93% of the studies. Implications of the discrepancy between effectiveness based on statistical evidence and clinical conclusions are discussed.

Child↗

PubMedDate not supplied

Early intervention for human immunodeficiency virus in Baltimore Sexually Transmitted Diseases Clinics. Impact on gonorrhea incidence in patients infected with HIV.

BACKGROUND: High incidences of sexually transmitted diseases (STD) after posttest counseling have been documented in patients diagnosed with human immunodeficiency virus (HIV) in Baltimore STD clinics. In July 1991, the authors instituted an HIV early intervention program providing long-term medical care and social work services. This study compares the incidence of gonorrhea after post-HIV+ test counseling in patients diagnosed with HIV before and after the institution of the early intervention program. METHODS: Medical records of a cohort composed of all patients newly diagnosed with HIV and those who underwent posttest counseling for HIV in 1991 to 1993 in two Baltimore STD clinics were reviewed. Patients were offered early intervention medical and social work services. Gonorrhea incidence in this cohort was compared to a historical cohort diagnosed and counseled for post-HIV+ testing in 1988 to 1989 who were not offered early intervention services. RESULTS: The mean follow-up time was 418 days (range, 26 to 703 days). After post-HIV+ test counseling, gonorrhea developed in 39 of 468 (8.3%) men in the 1989 cohort and 13 of 400 (3.3%) men in the 1991 to 1993 cohort. Controlling for variable length of follow-up, the 1991 to 1993 cohort had a relative risk of 0.442 for the development of gonorrhea during the study period (95% confidence interval, 0.225 to 0.790; P = 0.006). Incident gonorrhea after post-HIV+ test counseling also was associated with a prevalent gonorrhea condition at the time of HIV diagnosis (RR = 3.02; 95% CI, 1.75 to 5.23; P = 0.0001) and failure to return for post-HIV+ test counseling as scheduled (RR = 2.27; 95% CI, 1.17-4.43; P = 0.013). After adjustment for gonorrhea at the time of HIV diagnosis and failure to return for scheduled posttest counseling, the difference in gonorrhea incidence between men in the two cohorts remained statistically significant (RR = 0.494; 95% CI, 0.260 to 0.941; P = 0.032). In comparison, overall gonorrhea rates in Baltimore changed little between 1988 and 1993. No significant difference was found in gonorrhea incidence in women, which may have been the result of active gonorrhea screening during the 1991 to 1993 period, which was not performed in 1988 to 1989. CONCLUSIONS: Providing clinical care to persons with HIV may facilitate the reduction of high-risk behaviors that lead to incident STDs and further HIV transmission.

Adult↗

PubMed1998

Managed care's impact on Medicaid financing for early intervention services.

Medicaid has been a major source of financing for early intervention services since the inception of the Infants and Toddlers with Disabilities Program in 1986. In this article, the authors analyze Medicaid financing of early intervention services in 39 States before and after the introduction of managed care. The association between level of Medicaid financing and program characteristics, provider arrangements, managed care carve-out policies, and managed care contract requirements is assessed. The authors discuss the reduction of Medicaid financing after managed care and its implications for State Infants and Toddlers with Disabilities Programs, State Medicaid agencies, and managed care organizations.

Child, Preschool↗

PubMed1990

Preparation of occupational therapists to work in early intervention programs.

This paper presents the results of a survey of 43 occupational therapy academic programs regarding their preparation of students to work with young children with special needs. The number of instructional hours devoted to topics related to services for infants or toddlers and their families varied greatly. Some programs plan an increase in hours but are limited by the total hours available within the curriculum. This paper also shares the recommendations of a panel of occupational therapists with expertise in early intervention and entry-level education. The panel was concerned with the quality of preparation of therapists entering early intervention programs and encouraged the profession to review the amount of course work within each curriculum that introduces students to basic knowledge and skills related to early intervention. Some knowledge, such as the consultant's role and working with families of persons who are physically or mentally challenged, are common to other practice areas. The panel stressed that students be taught strategies for obtaining the training necessary for postgraduate entry into a specialty area such as early intervention.

Activities of Daily Living↗

PubMed1998

An outcome evaluation of a hospital-based early intervention program.

AIM: To determine the effectiveness of the Health Care Intervention Service (HIS), an early intervention program for general hospital patients with alcohol dependence or at risk for alcohol dependence. DESIGN, SETTING AND PARTICIPANTS: HIS consists of screening, assessment and assignment to either full or risk-reduction intervention. Full intervention includes a referral to treatment. Outcomes were compared across three groups: those who received a full intervention, those who received a risk-reduction intervention, and a comparison group of similar patients from hospitals with no HIS program. Patients were screened for alcohol involvement and interviewed during their hospitalization (prior to the intervention in HIS hospitals) and again 6 months following the intervention. FINDINGS: Full intervention was effective in increasing the probability of abstinence, reducing the number of heavy drinking days, and encouraging patients to accept the referral to treatment. Risk-reduction intervention was effective in reducing alcohol consumption and consequences, but only for those patients who had some signs of dependence at the first interview. CONCLUSIONS: HIS has demonstrated its effectiveness in a "real world" bureaucratic and clinical environment.

Adult↗

PubMed2003

Parent-mediated early intervention for young children with autism spectrum disorder.

BACKGROUND: Recent estimates concerning the prevalence of autistic spectrum disorder are much higher than those reported 30 years ago, with at least 1 in 400 children affected. This group of children and families have important service needs. The involvement of parents in implementing intervention strategies designed to help their autistic children has long been accepted as helpful. The potential benefits are increased skills and reduced stress for parents as well as children. OBJECTIVES: The objective of this review was to determine the extent to which parent-mediated early intervention has been shown to be effective in the treatment of children aged 1 year to 6 years 11 months with autistic spectrum disorder. In particular, it aimed to assess the effectiveness of such interventions in terms of the benefits for both children and their parents. SEARCH STRATEGY: A range of psychological, educational and biomedical databases were searched. Bibliographies and reference lists of key articles were searched, field experts were contacted and key journals were hand searched. SELECTION CRITERIA: Only randomised or quasi-randomised studies were included. Study interventions had a significant focus on parent-implemented early intervention, compared to a group of children who received no treatment, a waiting list group or a different form of intervention. There was at least one objective, child related outcome measure. DATA COLLECTION AND ANALYSIS: Appraisal of the methodological quality of included studies was carried out independently by two reviewers. Differences between the included studies in terms of the type of intervention, the comparison groups used and the outcome measures were too great to allow for direct comparison. MAIN RESULTS: The results of this review are based on data from two studies. Two significant results were found to favour parent training in one study: child language and maternal knowledge of autism. In the other, intensive intervention (involving parents, but primarily delivered by professionals) was associated with better child outcomes on direct measurement than were found for parent-mediated early intervention, but no differences were found in relation to measures of parent and teacher perceptions of skills and behaviours. REVIEWER'S CONCLUSIONS: This review has little to offer in the way of implications for practice: there were only two studies, the numbers of participants included were small, and the two studies could not be compared directly to one another. In terms of research, randomised controlled trials involving large samples need to be carried out, involving both short and long-term outcome information and full economic evaluations. Research in this area is hampered by barriers to randomisation, such as availability of equivalent services.

Autistic Disorder↗

PubMed1998

Is early intervention effective in preventing ADHD?

The purpose of this study was to examine whether early intervention by non-pharmacologic means (occupational therapy and speech therapy) can decrease the incidence of ADHD in a group of preschool children at high risk for developing this syndrome. Fifty-one children who suffered at the age of 2-4.5 years from inattention, speech delay and/or motor delay with or without hyperactivity were reexamined at the age of 8-10 years (average 8.9 +/- 1.0 years) by a developmental pediatrician and a developmental psychologist, using the following tests and questionnaires: WISC-R IQ test, Touwen and Prechtl neurological examination for soft neurological signs and the DSM-III-R questionnaire for parents and teachers for the assessment of inattention and hyperactivity. A detailed medical questionnaire was also completed. Of 51 children, 20 (39%) had ADHD. Of these 20 children, 8 had a history of ADHD in other siblings. We found that in children with a family history of this syndrome early intervention reduced the incidence of ADHD at school age although the small numbers limit conclusions and need further replication.

Analysis of Variance↗

PubMedDate not supplied

Prevention of intellectual disabilities: early interventions to improve cognitive development.

This paper presents a conceptual framework that has guided three randomized, controlled early intervention trials designed to improve cognitive development and social competence in high-risk young children from birth to 3 years of age. Two of the projects (Abecedarian and CARE) enrolled infants from economically and socially low-resource families and the other project (IHDP) was an eight-site randomized controlled trial with 985 low birth-weight and premature infants and their families. IHDP families varied widely in their economic and social resources. Results consistently indicated positive effects of the intervention on child IQ during the first 3 years of life. Children from the lowest resource families consistently benefited the most from the early intervention.

Child, Preschool↗

PubMedDate not supplied

Mucho camino: the experiences of two undocumented Mexican mothers participating in their child's early intervention program.

OBJECTIVE: This study describes the experiences of two mothers of Mexican origin who are immigrants living under undocumented status in the United States and who participated in their children's early intervention programs. METHOD: In-depth interviews, archival data, and participant observation conducted with two mothers of children with special needs provided data for this case study design research. A phenomenological analytical approach and qualitative data analysis software were employed to gain understandings particular to each family's experience. RESULTS: These families share similar experiences and interactions with many other families in the United States who live within the context of having a child with a disabling condition. Constraints on family functioning related to the families' status of undocumented immigration included: mothers as active participants in their children's early intervention programs, mothers' understanding of their children, mothers' communication with service providers, and life as an immigrant family of Mexican origin living under undocumented status. CONCLUSIONS: The examination of how these mothers negotiated family life while participating in their child's early intervention program provides an appreciation for how these families view the long road--"mucho camino"--involved in achieving their family's well-being.

Adult↗