Early intervention and Child development

1. 1
Dr.Chakravarthy.B
BPT,PGDEI,MSC

2. EARLY INTERVENTION
“It is the planned program deliberately t
imed and arranged in order to alter the an
ticipated or projected course of developme
nt”
Seigal 1972

3.  In pediatrics “Early” refers to the most cr
itical period of a child’s development (0-3
years) and “Intervention” means giving a c
hild a variety of opportunity to experience,
explore and play with things around.

4. Early Intervention is a term broadly ref
ers to a wide range of experience and s
upport provided to children, parents a
nd family during pregnancy, infancy an
d early childhood development.

5. AIMS OF EARLY INTERVENTION
• Prevention of developmental delay and disability.
• Screening and identification of at risk children
• Stimulating the child through the normal developmenta
l channels
• To enhance normal development and independent fu
nctioning of the child
• Maximize the child’s residual capacity
• Minimize the need of future therapy and special educ
ation.
• Increase the family awareness and involvement in inte
rvention that will enhance the child’s development

6. • To prevent secondary handicaps.
• To plan the assesment and intervention
• Acceleration of rate of development
• To increase the family awareness and involvem
ent in intervention that will enhance the child dev
elopment

7. FOCUS OF EARLY INTERVENTION
 Screening
 Identification
 Prevention of disability or delay
 Promotion of positive assets of a developmentally delayed child
 Enhance the capacity of the family to meet the special needs of t
heir infants and toddlers

8. RATIONALE FOR EARLY INTERVENTION
 Rapidity of growth and development
 Sensory motor peri0d
 Critical period
 Neuroplasticity
 Myelination
 Brain growth
 Motor development
 Language development
 Personality traits
 Temperment
 Attachment
 Social development and learning.

9. Nature of population requiring early intervention
All the children need stimulation to grow physically and
even more cognitively
Infant and children environmentally at risk Ex: Poverty, L
ow socio-economic status.
Infant and children at increased biological risk Ex: LBW, p
re-mature birth
Children with Established developmental delays
All childhood disabilities (VI,HI, CP, Speech language com
munication delay)

10. APPROACHES IN EARLY INTERVENTION
A team approach would be beneficial as ea
rly intervention is a field where professiona
l services are required from various discipli
nes contributing to the Child’s developm
ent.
Inter disciplinary
Multidisciplinary
Trans-disciplinary

11. A B C D
Child
A B C D
Child
MultidisciplinaryInterdisciplinary
A B C D
case manager
child
Tran disciplinary
Holistic approach
Better case management
Better resource management
CBR Approach
Greater coverage of services

12. FACTORS INFLUENCING EARLY INTE
RVENTION PROGRAM
 Parent Involvement
 Parent Motivation
 Parent education
 Delivery Model
 Home Environment
 Availability of Services
 Cost Effectiveness
 Intensity
 Duration
 Curriculum content

13. CRITERIA FOR ELIGIBILITY FOR EIS
 At risk for developmental delay
 Children who have developmental delays
 Zero rejection
 Birth to 3- 5 years
 Degree of severity
 Type of disability (visual, hearing etc)
 Children with established condition.

14. •Congenital anamolies
•Metabolic disorders
•Genetic disorders
•Congenital infections
•Autism
•Hearing loss
•Visual impairment
•Neurological dis order (cp, spina bifida,
epilepsy, microcepaly etc )
•Neonatal conditins and associated complications
1 premature or lbw
2 neonatal encephalopathy
3 CHD
4 Jaundice
5 IUGR

15. Role of therapist in Early Intervention
• Screening
• Identification and classification
• Programming and intervention
• Evaluation

16. ACTIVITIES OF EARLY INTERVENTION UNIT
 Consultancy
 Assesment
 Intervention programmes
 Counseling and guidance
 Interdisciplinary team members

17. ASSESMENT
BASIC APPROACHES IN ASSESMENT
 Formal vs informal.
 Direct vs indirect.
 Norm vs criterian referenced tests.

18. Developmental delay
 Developmental delay means:
When the child is unable to accomplish the de
velopmental task considered appropriate to t
he chronological age
Or, not attained the specified developmental
milestone at the expected times

19. Developmental Disability
 Condition that originate prior to age 18
 Has continued or is expected to continue indefinitely
 Constitute a substantial handicap in normal functionin
g
 MR
 CP
 AUTISM
 EPILPSY
 DYSLEXIA

20. At Risk Baby
 A child is consider to be at risk due to adve
rse genetic, prenatal, perinatal, postnatal a
nd environmental influences that may lead
to subsequent developmental delay or devi
ation.

21. FACTORS & VARIABLES CAUSING DEVELOPMEN
T DELAY
 IUGR
 Culture
 Families ( nucl, comb etc)
 Inter house interaction
 Personality
 Attachment
 Home environment
 Maternal age
 Race (male, female)
 Socio-economic status
 Parental education
 High risk pregnancy
 Poor & deficient home environment
 Poor family resources
 Family support
 Parental stress

22. CAUSES
&
PREVENTION

23. PRENATAL CAUSES
 Maternal age
 Physical built
 General health
 Nutritional status
 Multiple gravida
 Less birth spacing
 Abortions
 Infections – TORCH,STD
 Diabetes
 Hypertension
 Rh incompatibility
 Drugs
 Chemicals/Poisons
 Exposure to x-rays
 Alcohol and smoking
 Physical trauma
 Emotional Trauma
 Genetic and chromosomal

24. NATAL CAUSES
 Prolonged labour
 Difficult delivery
 Arrested labour
 Abnormal presentation
 Placenta previa (abnormal positioning of placenta)
 Cord around the neck
 Delayed birth cry
 Twins and multiple pregnancies
 Caesarian section
 Forceps/ vacuum extraction
 Injury during delivery
 Pre/post term deliveries
 Neonatal seizures

25. POST NATAL CAUSES
• Infections
• Nutrition – LBW
• Prematurity
• Injury
• Metabolic disorders
• Endocrinal disorders
• seizures

26. PREVENTION
 Primary prevention
 Action taken prior to the onset of disease which removes possibility that the disease will occur
 Levels of primary prevention
Pre pregnancy
Avoid teenage & late pregnancy
Planned pregnancy (3 months before)
complete blood picture
maintenance of good health
proper birth spacing
supplementation of folic acid
 Prenatal
 Regular Ante Natal Check-ups
 Nutrition
 Hygiene
 Avoid trauma
 Avoid exposure to drugs or radiation
 Genetic counseling

27. Natal
 Hospital delivery / trained Dai
 Monitoring of the new born
 Hypoglycemia, hypothyroidism management
 Rapid treatment of anoxia
 Protection of eyes
Post Natal
 Nutrition
 Growth monitoring
 Child rearing practices
 Prevention of trauma
 Immunization

28. Secondary prevention
Defn: Action which halts the progress of the disease at its incipient sta
ge and prevents further complication
Early identification
Adequate treatment
Suitable intervention
Prevents secondary complication & long term disability
Tertiary prevention
Defn: All measure available to reduce or limit impairments & disabilitie
s and minimise suffering caused by existing disability.
Rehabilitation
Utilization of existing capacities
Combine and coordinated use of medical / Social /
Educational & vocational measure.
Optimum level of functional ability

29. AREAS WHICH REQUIRE SCREENING:
 Reflexes
 Vision
 Hearing and speech
 Locomotion
 Cognitive

30. NEW BORN REFLEXES
PRIMITIVE REFLEXES
 Rooting(0-3)
 Sucking(0-3)
 Moro response(0-6)
 Startle response (rem)
 Palmar grasp (0-4)
 Plantar(0-9)
 Flexar withdrawl(0-2)
 Crossed extension(0-2)
 Possitive supporting reaction(2-4 &5-7)
 Gallant reaction(0-2)
 Placing (rem)
 Walking/stepping(0-2)
 ATNR(0-6)
 STNR(5-7)
 TLR(2-3)

31.  MID BRAIN
 Neck righting(5m)
 Body on body righting(4m-5yr)
 Body on neck righting(4m-5yr)
 Landua (3m-10m)
CORTEX
 Parachute reaction (4m-9m)

32. VISION
 Vision is the primary data-gathering system of human organism.
 Only vision can perceive shape, size, color, distance, spatial location-all in one glance.
 The variety of information we get through this sense is un-comparable.
 When the child is born the visual capacity of the child is very limited.
 It is the least developed sense at birth although this sense organ is the first to be for
med in fetal life.
 Visual skills develop in an orderly sequence

33. Vision helps us in
 Learning by seeing things
 Moving freely in our environment
 Reaching to objects
 Locating the source of sound, light
 Vision can perceive shape, size, color, distance, spatial
location-all in one glance.
 Moreover alerts us about the environment. (both help
ful and dangerous situation)

34. Basic Visual skills
 Fixation- The ability to focus on an object is called fixatio
n- 1 to 2 month
 Tracking- means, the two eyes moving together to follow
an object- 3 to 4 month
 Localization- The ability to locate the source of stimuli is c
alled localization. Visual localization is the ability to visua
lly locate the stimuli – 3 to 4 month

35. Other important skills related to vision
 Eye contact- Eye contact is the basic skill in socialization and
communication- 2 to 3 month
 Self awareness- Self-awareness is the realization of our bod
y- 3 to 4 month
 Eye hand coordination- This is the ability to use the eye and
hands in a coordinated fashion-4 to 6 month
 Gaze shift- The ability to look at one object and then to shif
t the attention to another object is called gaze shift. (4 to 6
months).

36. Warning symptoms for visual impairment in i
nfancy
 Child is not maintaining eye contact by age of 3 months.
 Poor visual fixation/ following even after 4 month.
 Insufficient accuracy in reaching after 6 months of age.
 Not preferring lighted area/ Show discomfort to bright light.
 Excessive rapid eyeball movements.
 Excessive rubbing of eyes.
 Excessively clumsy.
 Not responding to familiar face.

37. Warning symptoms for visual impairm
ent according to age
 0-3 months
 Infant does not follow an object in his visual fields Infant does
not play with his hands.
 Baby does not make eye contact when being fed or cuddled.
 3-6 months
 Baby does not reach for toys in his visual field.
 Baby does not make eye contact when being fed or cuddled/
 Baby does not visually inspect objects in his hand.
 .

38.  6-9 months
 Skills of a baby do not develop such as rolling over sitting or crawling
 (Delay in motor milestones)
 Baby does not appear to discriminate between similar objects or people.
 Baby does not pick up objects successfully.
 Baby holds play things very close to the eyes.
 9-12 months
 Baby bumps into large objects when crawling.
 Baby does not appear to notice interesting or bright coloured objects t
hat are at a short distance.
 Baby does not imitate simple motor play such as waving bye-bye.

39. Other indicators
 Redness of the eyes
 Excessive discharge or water from the eyes
 Drooping eyelids
 Cloudy or dry eyes
 Pupils are uneven in size
 Visible irregularities in structure of the eye
 Recurring swollen lids

40. Vision and its impact on other areas of develo
pment
 Motor Development
 Cognitive development
 Social development
 Speech and language development
 Play development

41. HEARING
 Hearing is the reception of the sound by the ear and its tran
smission of message to the brain
 Hearing is a prerequisite for the development of normal spe
ech & language.
 Presence of startle reflex is the chief milestone for hearing.
 It develops 22-26 wks in utero.


42. Hearing screening checklist For Early I
dentification
 Birth to 3months
 Q1 Does your child wake up at loud noises Yes/ No
 Q2 Does your child startle or cries at loud noise Yes/No
 Q3 Does your child stop crying on hearing human voice Yes/ No
 3 to 6 months
 Q1 Does your listen to soft sound Yes/ No
 Q2 Does your child frightened or disturbed by angry voices Yes/No
 Q3 Does your child seem to recognize mother’s voice Yes/No
 Q4 Does your child stop on going activity and appear listen to sound or speech
Yes/No
 Q5 Does your child turn or try to turn towards the speaker or sound Yes/No

43.  6-9 months
 Q1 Does your child respond to his / her name Yes/No

 Q2 Does your child turn towards the side where the sound is coming from
Yes/No
 Q3 Does your child produce sound to get attention of others Yes/No
 9 to 12 month
 Q1 Does your child look around for source of sound stimuli Yes/No
 Q2 Does your child respond to simple command by verbal/non verbal Yes /No
 Q3 Does your show interest in rhymes, music, play Yes /No

44.  12 to 18 months
 Q1 Does your child communicate with simple words Yes/No
 Q2 Does your child show interest in conversation with family members. Yes/No
 Q3 Does your child use both words and gestures for communication Yes/No
 Q4 Does your child able to distinguish various kind of sound Yes/No
 Q5 Does your child can hear you when you call from another room Yes/No
 18 Months to 3 years
 Q1 Does your child improve vocabulary Yes/No
 Q2 Does your enjoy listening to stories Yes/No
 Q3 Does your child understand speech even in the absence of visual cues Yes/No

45.  3 years and above
 Q1 Does your child pronouncing most of the words correctly Yes/No
 Q2 Does your child understand simple sentence with out repetition
Yes/No

 Q3 does your child responds your question verbally Yes/No

 Q4 Does your child not favor one side for listening Yes/No
 Q5 Does your child is able to speak properly Yes/No
 (In each group more than 50% of check list gives ‘No’ r
esponse. Refer the child for detail evaluation
 by an audiologist or ENT specialist or your nearest PHC)

46. Warning signs of hearing abnormalities.
 Not responding – to loud noises, clapping sound at one foot dista
nce, sound of a
rattle
 Not locating the sound source
 Absence of cooing and babbling even at 1 year
 Absence of spontaneous vocalization
 Inability to understand simple command even at 18 month

47. Guide to Parents of Children with Heari
ng Impairment
 Encourage your child to wear the hearing aid for all his waking hours.
 The child should be exposed to only one language until he develops his basic l
anguage skills (a second language can be introduced at appropriate age)
 Face your child while speaking
 Talk to the child all the time in a natural manner and give him adequate time
and opportunity to express himself.
 Don't avoid talking to the child assuming that he will not understand.
 Encourage him to attend to you when you speak
 Your imitation of your child's utterances is extremely useful in encouraging him
to speak.
 Talk to your child in simple short sentences.
 Encourage your child to imitate your speech/lip movements as it facilitates his
attempts to speak.

48. SPEECH AND LANGUAGE
 LANGUAGE ACQUISITION
 Language learning starts at birth. Even new babies are aw
are of the sounds in the environment .
 The development of language is orderly and hierarchical.
 Important stages are,
Pre speech vocalization
First words
Combining words

49.  Pre speech vocalization
This stage lays foundation for true speech.
The pre speech vocalization consists of,
Reflexive utterances (0-3 month)
Babbling (3-8 month)
Use of inflection (7-12 month)
True speech
 First words (11-15 months)
 Combining words (14-18 months)
 Two-three word sentences (18-24 months)
 Development of complex sentences (24-36 months)

50. Vocabulary growth
 0-10 month -0 words
 10-12 months -1 word
 12 month----3 words
 15 month----18 words
 18 month----22 words
 21 month----118 words
 24 month----270 words
 30 month----445 words
 36 month----900 words

51. Loco-motor Disability
 Locomotor disability is defined as a person's inability to
execute distinctive activities associated with moving bo
th himself and objects, from place to place and such ina
bility resulting from affliction of musculoskeletal and/or
nervous system.
 RCI Act 1
992

52. MOTOR MILESTONES
 Able to clear the nose 0-1 mth
 Head hold/neck control 3-4 mths
 Role over 5-6 mths
 Sitting with support 6-7 mths
 Creeping 7-8 mths
 Sitting without support 7 -9 mths
 Crawling 8 -10 mths
 Standing with support 9-10 mths
 Walk with support 9-11 mths
 Standing without support 11-12 mths
 Walking without support 11-13 mths
 Running 1 ½ yrs
 Climbing stairs step to pattern 2 yrs
 Stair climbing & tricycling 3 yrs

53. FINE MOTOR DEVELOPMENT
 0-3 mths eye to eye contact and hand opening.
 4 mths palmar grasp and
 5 mth reaches the object with ulnar grasp
 6 mths hand to foot play.
 7 mths transfering the objects from one to another hand
 8 mths voluntary releasing of objects.
 9 mths pointing with hand
 10 mths pincer grasp
 1 yr pointing with index
 15 mths scribbling
 2 yrs builds tower 6-7 cubes
 3 yrs copies circle

54. Early identification of loco-motor disa
bility
 Inability to lift head up when pull to sit or lying on stomach at the age of 4 month
 Difficulty in sucking and swallowing.
 Inability to roll over even after 6 month of age.
 Poor reach and grasp
 Holding the extremities too tight
 Holding the extremities loose ( floppiness)
 Too much of irritability.
 Not able to creep or crawl even after 7months

55. COGNITION
 It refers to the processing of information about the
environment that we received through the senses.
 The process of cognition involve are :
 1)Attending 2) Remembering 3) Symbolizing, 4) Categorizing
 5) Planning 6) Reasoning 7) Problem solving 8) Creating
 9) Fantasying etc
 Term used for cognitive impairment are Mental deficiency, mental sub no
rmality, mental handicapped, mental retardation etc
 “Intellectual disability”- New term- American Association on Intellectual
and Developmental Disabilities (AAIDD)

56. Mile stones of cognitive development
 0-2 month Smiles at familiar faces while talking
 3 month Recognizes the mother
 5 month Smiles at own image in mirror
 6 month Laughs at peek-a-boo game
 7 month Responds to own name
 8-9 month Responds to “no” ,shows likes and dislikes
 10-12 month Waves like bye-bye, & may kisses on
request
 15 month Negativism begins
 1 ½ yr Knows some of the body parts & obeys 2-3
simple requests.

57.  2 yr Names few objects & participates in parallel play.
 2 ½ yrs Begins to take interest in sex organs & peak of neg
ativism.
 3 yrs Constantly asks questions & begins to draw specific obje
cts.
 4 yrs May make up silly words and stories
Can read own name
 5 yrs Tell long stories
Begins to understand the difference between real events and
make believes ones.
Asks meaning of words.

58. Common features in cognitive d
eficits
Delayed milestones
• Child cannot express and use words according to age
• Child is slow to imitate and sometimes may not imitate at all
• Child cannot attend for a longer time on a single activity
• Child’s fine motor and play when compared
• Small or large head
• Small stature
• Protruding tongue
• Blunt features
• Drooling
• Can not walk with good coordination

59. PHYSICAL GROWTH OF CHILDREN
AGE BOYS GIRLS
HEIGHT IN C
M
WEIGHT HEIGHT WEIGHT
BIRTH 45.9-51.7 2.4-3.4 45.9-50.6 2.2-3.3
1M 51.2-55.6 3.1-4.77 48.1-56.6 3.2-4.5
2M 53-60.6 3.7-5.7 52-59.1 3.5-5.2
3M 57.1-63.8 4.7-6.8 53.8-61.6 4.5-6.2
6M 61.5-68.4 5.5-8.3 59.7-67.7 5.5-7.9
9-1 YR 65.3-78.3 6.5-10.8 64-76.6 6.08-10.5
1-2YR 69.3-84.4 7.2-11.6 69-81.4 6.8-10.9
2-3 YR 82.5-94.2 10.2-14.5 81.9-91.2 10.5-13.6
4-5 YR 92.2-110.8 11.4-21.8 92.5-108.8 12.9-19.4

60. DEVELOPMENTAL AREAS
Sensory – Motor
Socio – emotional
Speech, Language & Communication
Cognitive

61. Simulative activities for
Visually impaired
children

62.  Maintain eye contact with the child.
 Use contrast colored material as stimulating object.
 Use big size colorful toys.
 Maintain head and hands in midline while interacting with the child.
 Encourage horizontal tracking first later vertical.
 Use sound making toys in association with light when training for localization.
 Colorful torch light can be used in a dark room at beginning
of stimulating tracking

63.  Encourage child to establish and maintain eye contact or attention span for lo
nger duration.
 Encourage play with own body to improve self awareness.
 Encourage child to imitate both sound and action , assist him whenever neces
sary.
 Encourage activities, play in frond of a mirror.
 Flash light from two different direction and encourage child to locate it.
 Use toys, utensils, clothes, and other material very colorful.
 Encourage the child to manipulate and feel objects with hand
and other senses

64. COMMON INTERVENTION STRATEGIES FOR A
CHILD WITH HEARING IMPAIREMENT
 Teaching comprehension skills.
 Teaching instruction following.
 Imitation training.
 Teaching expressive skills

65. Common technique for speech and language s
timulation
 Face to face interaction, proper positioning.
 Child's interest.
 Parental imitation. (both verbal and non-verbal)
 Not anticipating need or desire.
 Work on pre-verbal skills.
 Delaying response to gestures.
 Parent's speech-slow, clear simple speech.


66. CONTI,,,,,,
 Modeling –encourage verbal imitation.
 Prompting (labeling ).
 Binary choice.
 Questioning.
 Sentence completion.
 Expansion.

67.  Reinforcement.
Parallel talk.( What child is doing,
seeing, hearing, feeling)
Self talk (what you are doing, seeing,
hearing when the child is nearby)
Reading books ,stories
Expansion.
Stimulating environment.
Speech mechanism.
Vegetative skills,

68. Early intervention of children with cog
nitive impairment
 Sensory motor stimulation (Early stimulation and play)
 Parent child interaction
 Language training
 Facilitate normal milestone
 Self help skills training
 Social skills training
 Cognitive stimulation

69. Essential Component of Therapeutic Assessm
ent in Early Intervention
• TONE
• MOTOR DEVELOPMENT
• POWER
• REFLEXES
• POTURE, BALANCE
• NUTRITION
• INVOLUNTARY MOVEMENTS
• RANGE OF MOTION
• TIGHTNESS, CONTRACTURE, DEFORMITY
• CHILD’S SENSORY COGNITIVE AND
• COMMUNICATIVE ABILITIES

70. Therapeutic techniques
 NEURODEVELOPMENTAL THERAPY
 ROOD’S APPROACH
 VOJTA THERAPY
 MYOFACIAL RELEASE
 SENSORY INTEGRATION
• PROPRIOCEPTIVE NEUROMUSCULAR FACILITATION
• HYDROTHERAPY
• ASSISTIVE DEVICE
• GAIT TRAINING
• DEVELOPMENT OF PLAY,HAND FUNCTION AND
 ORO-MOTOR FUNCTIONS

71. Individualized Early Intervention Programme
It is a document prepared by a group of pr
ofessionals who participate in intervention
program or by a professional who is traine
d in early intervention.

72. Factors should be considered during pre
paration of IEIP
 Child’s present potential
 Child’s and families needs.
 Family condition
 Relationship
 Socio-economic status
 Participation of other members

73. THANK YOU