I. Definition and Scope of Early Intervention.
Early intervention refers to an organized, purposeful educational activity that enriches the environment. It is used for children before the age of 5 to 6 years whose development deviates from normal or is likely to deviate from normal. With this intervention, it is expected that these children will improve their intelligence or catch up with the development of normal children.
The acquired factors that affect the development of intelligence in children are environmental high-risk factors and biological high-risk factors. Perinatal high-risk children fall into the latter category. Perinatal high-risk infants include: preterm and low birth weight infants, perinatal asphyxia, persistent hypoxia, and intracranial hemorrhage (grade III-IV). Due to the establishment and development of neonatal intensive care units (NICU) in recent years, the survival rate of newborns has increased, accompanied by an increased incidence of neonatal neurological disorders, especially among preterm infants, with an increased number of brain injuries, mainly cerebral palsy, mental developmental disorders [IQ or DQ less than 70], other hearing or visual impairment, delayed motor function development, abnormal muscle tone, low social and adaptive skills, and attention deficit. The other problems include hearing or visual impairment, delayed motor function, abnormal muscle tone, low social and adaptive skills, and inattention. It has even been suggested that the normal developmental performance of low birth weight infants during infancy is not indicative of normal development later in life. In recent years, some have tracked at-risk children through preschool and even found that a significant proportion (40-60%) of children who do not have disabilities by school age need special education and additional help in school. This will create a heavy burden for society and families.
In order to implement the national policy of eugenics, in addition to strengthening perinatal health care and medical treatment and preventing asphyxia, early behavioral evaluation and early intelligent intervention for at-risk children to effectively prevent and treat disabilities and improve the prognosis are urgent problems to be solved.
Effectiveness of Early Intervention
Early intervention began in the 19th century and developed relatively quickly in the 20th century. Many scientists have demonstrated that early intervention has significant effects on children who are intellectually backward or at risk due to environmental or biological factors.
In the early 1990s, the largest sample of children in the U.S. Infant Health and Development Program was divided into early intervention and regular follow-up groups based on random assignment of nearly 1,000 low birth weight (less than 2,500 grams) and preterm (less than 37 weeks) infants. At 36 months, the IQ (intelligence quotient) of children in the intervention group was 13.2 points higher than that in the regular follow-up group (weight 2-2.5 kg group) and 6.6 points higher (weight less than 2 kg group). Early intervention can promote asphyxiated infants to be able to develop and help prevent their low intelligence, as well as to promote the intellectual development of preterm infants. (For specific educational programs, see “Newborn behavior and education from 0 to 3 years old”).
Third, the importance of early intervention
1, in the first few years after birth is a period of more rapid development of the brain, intelligence and social adaptability of the child than any other period. From the brain weight, the newborn brain weighs 370 grams, 700 grams at 6 months (accounting for 50% of adults). 2 years old before the fastest growth. Over the past 20 years of research and practical experience in countries around the world have provided us with a deeper understanding of the physiological functions of the human brain and its development, such as the DNA curve with two peaks, one reflecting neuronal proliferation in mid-gestation and the other reflecting the proliferation of glial cells in the first months of life. This is accompanied by an increase in brain weight, dendritic development and synaptogenesis. The period of neuronal proliferation in the human brain is from the first 3 months of gestation to the first year of life, after which the neuronal cells no longer replicate or regenerate. In contrast, the proliferation of supporting cells that maintain nerve cell nutrition and conduction continues from the second trimester to the second year of life. Before 2 years of age, good parental stimulation has an important impact on brain function and structure, both physiologically and biochemically.
2, plasticity of the immature brain in response to injury: brain plasticity is defined as functional adaptation to neurological deficits caused by injury to brain structures. The immature brain has the strongest plasticity capacity. Physiological death of neuronal cells increases due to the influence of harmful factors. However, some areas of the brain are able to regenerate new neuroblasts even after birth, as exemplified by the outer granular layer of the cerebellum. Impaired neuronal migration is the main cause of brain dysplasia. However, not all of them follow the genetic program. Late neuronal migration persists in the cerebral cortex until 5 months postnatally and in the cerebellar cortex until 12 months postnatally. Structural damage caused by intracerebral hemorrhage and embolism in preterm infants can interfere with late neuronal migration. In some cases, even if neurons are heterotypic and the normal structure of the cortex is destroyed, it is still possible to form pathways functionally, with compensatory adaptations including axonal bypass projections, unusual bifurcations of dendrites, and the generation of unconventional synapses. These changes play an important role in the plasticity of the brain.
3, the critical period of intelligent development: many psychologists have studied the critical age of learning, that is, at a certain age to learn things faster and better, after this age, and then to learn is not as good as the critical period of learning. 5 to 6 years old before a person’s psychological and intellectual development is a critical period. Early years are very important for a person’s development, for both normal and mentally retarded children. Therefore, the quality of early intellectual development directly affects the future quality of the population.
The age of onset of early intervention is best for at-risk children starting from the neonatal period. Neonatal 20-item behavioral neurological measurements have predictive value for the prognosis of asphyxiated infants, and can also be used as a clinical basis for early intervention if the 7-day postnatal score is less than 35 for abnormalities.
IV. Types and methods of early intervention
1.Types of intervention.
(1) Directly targeting the intervened infant, either by individual development-promoting stimulation in the infant room or by concentrating the infant in a training center for group education.
(2) Indirectly by instructing parents to train the subject of intervention. Parental guidance begins after the birth of the infant to promote parent-child interaction and improve the parent-child relationship. Later, the instructor further instructs the parents on how to reasonably and effectively promote the infant’s intellectual development.
(3) A combination of direct intervention for infants and guidance to parents for intervention.
2. Methods of pre.
Neonatal period: early additional stimulation and/or environmental change stimulation is given for the main sensory body of the body.
The four main modalities of developmental intervention for newborns are
(1) auditory stimulation: by talking, singing and playing music to the infant, recording of the mother’s voice and heartbeat, etc.
(2) Visual stimulation: by showing the infant something with bright colors that can be moved, or by having the child look at the parent’s face.
(3) tactile stimulation: passive flexion of the limbs, touching and massage, and changing the infant’s posture, etc. The nasally fed sick child can practice non-nutritive sucking movements
(4) vestibular motor stimulation: giving rocking and oscillation (e.g., water bladder bed). Different combinations of the above interventions are arranged. Because of individual differences, intervention plans vary from person to person. In neonatal hydrotherapy, developed in recent years, the equipment consists of a comfortable basin with warm water in which the preterm infant is immersed and a suspended radiant heater is placed over the basin. Hydrotherapy is associated with tactile stimulation, such as stroking or postural changes.
V. Procedures for early intervention
A comprehensive team of doctors, nurses and health care workers should receive some training at the beginning to learn about relevant knowledge such as psycho-behavioral characteristics and developmental patterns of newborns and infants. The tasks, goals and methods of early intervention should be clearly defined, and later on in the work they should regularly focus on training in research projects to ensure quality.
1, intervention in the neonatal period, conditional units can be carried out in the neonatal ward.
2.For parental guidance of newborns, the purpose of early intervention should be explained to the parents of newborns as soon as possible after birth to improve the prognosis of high-risk children, answer questions raised by both parents, and sign an agreement. Explain to the parents the capabilities of the newborn, do demonstration, teach the parents the way to interact with and comfort the newborn, and know how to distinguish the various states of the newborn. Enable parents to actively and correctly carry out early intervention.
3. Post-discharge intervention and regular follow-up. Preferably at least once a month in the first year and once every 1-2 months in the second year. Each visit should have specific requirements. According to the development of the child, make the next intervention requirements.
4.Regular (2-3 months) parent meetings, including lectures, introduction of age-appropriate toys, baby books and magazines, exchange of experiences, etc.
5.Children are concentrated in the early intervention center for direct intervention (day care method).
VI. Effectiveness assessment.
1.Intelligence assessment: using various intelligence testing methods.
2.Medical assessment: physical development indicators, disease conditions.
3.Environmental and maternal condition assessment.