Podsumowując Wczesną Interwencję
Od blisko 40 lat zastanawiano się nad skutecznością Wczesnej Interwencji w różnych formach. Pierwsze badania porównawcze z początku lat 70tych pokazywały istotną różnicę w rozwoju dzieci “ćwiczonych” i nie “ćwiczonych”. W latach 80tych, gdy ustalano “porządek” i zakres ćwiczeń rehabilitacyjnych zwrócono uwagę na fakt znacznego rozwoju w zakresie motoryki dzieci z ZD. Gdy pod koniec lat 90tych wprowadzono do programu ćwiczenia stymulujące mowę i mięśnie twarzy zauważono kolejny duży postęp dzieci z ZD. Nie bez znaczenia był także fakt znaczących postępów medycznych, które w znacznym stopniu wsparły procesy terapeutyczne.
Były też w tym okresie oceny negatywne programu, gdzie rodzice wyrażali swój żal, iż pomimo duże wysiłku nie osiągnęli z dzieckiem tego co oczekiwali.
Rok 2000 stanowi pewną granicę. W tym to okresie pojawiały się w szkołach podstawowych pierwsze dzieci z “szerokich” programów terapeutycznych. Porównania możliwości potwierdzały, że dzieci po Wczesnej Interwencji funkcjonowały dużo lepiej ruchowo oraz poznawcza. Zdecydowanie poprawiało to ich funkcjonowanie, ale nie powodowało zdecydowanego przyrostu umiejętności poznawczych czy też socjalnych. Szczególnym ograniczeniem była w tym okresie komunikacja werbalna. Z tego też powodu po 2000 roku wprowadzano do programu Wczesnej Interwencji zajęcia typowo logopedyczne, terapię logopedyczną wspomagającą funkcjonowanie mięśni twarzy dziecka z ZD oraz zajęcia z Integracji Sensorycznej oraz zajęcia grupowe.
Po 2004 roku wprowadzono do Wczesnej Interwencji programy sportowe mające umożliwić zwiększenie sprawności ruchowej i stabilności.
Obecnie Wczesna Interwencja jest programem ściśle związanym z korektą dysfunkcji dziecka z ZD. Kolejne generacje dzieci uczestniczących we Wczesnej Interwencji docierają do szkół, w których to okazuje się, że są sprawniejsze, mają lepszą percepcję i koncentrację. Dzieci te w USA niemalże w 100% kończą High School, a wiele z nich trafia do collegów. Uważa się, że w przypadku, gdy zmiany organiczne jakie są konsekwencją zespołu Downa, będą mogły być choć w minimalnym stopniu korygowane medycznie, to oba te pola wsparcia, umożliwią osobom z ZD studiowanie na wydziałach humanistycznych i samodzielne życie.
Infants and Young Children 17 (1): 45-58 (2004 Jan/Feb/Mar)
Down Syndrome: Genetic Insights and Thoughts on Early Intervention
Capone, George T.
Department of Neurology and Developmental Medicine, Kennedy Krieger Institute, Baltimore, Maryland 21205, USA
The neurobiological consequences of trisomy 21 remain incompletely understood. Considered as a syndrome-complex of chromosomal (genetic) origin with multiple neurodevelopmental and neuropsychological manifestations it will be a very long time before a complete understanding of this condition emerges based upon molecular, genetic, and neurobiological principles. The construct of Down syndrome (DS) as a developmental disorder is, by itself, incomplete and most unsatisfactory based upon emerging biological concepts. However discussions of DS as a developmental disorder characterized primarily by developmental delay, does permit highly complex biological events to be easily conceptualized in terms of the whole child. Our current models of child development and the interventions designed to support neuromaturation in young children with DS will require further integration with emerging genetic, neurobiological, neuropsychological, and pharmacological paradigms. A cogent framework for successful pharmacological treatment of certain aspects of cognitive and behavioral dysfunction is beginning to emerge. At the same time, a growing number of untested, nutrition- and development-based therapies are continually offered to the families of young children. The need for well-designed studies to measure the effects of early, focused clinical intervention of any kind is obvious. Our ability to competently serve young children with DS will advance once a commitment to clinical trials is recognized and acted upon.
J Dev Behav Pediatr 22 (3): 153-62 (2001 Jun)
The effects of early motor intervention on children with Down syndrome or cerebral palsy: a field-based study.
This study reports the results of a field-based investigation of the effects of two motor intervention approaches–neurodevelopmental treatment and developmental skills—on children with two different diagnoses. The sample included 50 children, of whom 27 were diagnosed as having Down syndrome and 23 as having cerebral palsy. Children had a mean chronological age of 14 months at the beginning of the study. The severity of their motor impairment was assessed with the Gross Motor Function Classification System for Cerebral Palsy. Children’s motor functioning was examined at entry into the study and after they received 1 year of motor intervention services. Dependent measures included children’s general development, rate of motor development, and quality of movement. Pre-post comparisons indicated that children made significant changes in their motor development age and quality of movement over the course of intervention. However, there was no evidence that motor intervention accelerated development or improved quality of movement beyond what could be expected on the basis of maturation. Furthermore, no differential intervention effects were associated either with children’s diagnosis or treatment model. Regression analyses indicated that the rate of motor development children attained after 1 year of intervention was highly related to their rate of development at the onset of intervention and, to a lesser degree, to the number of sessions of intervention children received. These results are discussed in terms of the need for the field of motor intervention to develop new treatment paradigms.
Infants and Young Children 12 (3): 23-31 (2000 Jan)
Early Intervention in Children with Down’s Syndrome: From Evaluation to Methodology
Institute for Pedagogical and Social Support, Graz, Austria
This article focuses on the European experience with early intervention for children with Down’s syndrome. After two decades of evaluation, there is a need for a debate on its methodology. Early intervention for children with Down’s syndrome is viewed, in this article, as a reconstruction of the construction process of the child in order to facilitate optimal response to environment conditions. It demands communication skills, a high level of transparency, theoretical education, and trust in the resources of the child.
International Journal of Disability, Development and Education 45 (3): 253-281 (1998)
Early Intervention, Families, and Adolescents with Down Syndrome
Crombie, Mary; Gunn, Pat
Fred and Eleanor Schonell Special Education Research Centre, The University of Queensland, Brisbane Qld 4072, Australia
Developmental assessments are reported for two cohorts of Brisbane children with Down syndrome at chronological ages from 11 to 14 years. Cohort 1 was born during 1973 to 1974 while Cohort 2 was born from May 1976 to December 1978. These cohorts provided an opportunity of studying the long-term effects of early intervention as a history-graded influence on development; one cohort was born before early intervention became widely available whereas by the time the other children were born, a variety of programs were being offered [to] children with disabilities. No significant cohort differences were found in MA at 11 years, 12 years and 14 years CA, in non-verbal scores at 11 years and 12 years CA, or in adaptive behaviour scores near 13 years CA. There was no evidence of a final plateau in MA. When the cohorts were divided in the basis of early intervention commencement age, frequency and duration of attendance, there were again no group differences. SES, mothers’ education, and gender were significant predictors of MA but gender did not add significantly to non-verbal scores. Cognitive function was strongly associated with adaptive behaviours. It was concluded that early intervention studies need to investigate social disadvantage and biological impairment not only as separate issues, but as a combination of the two. There is also a continuing need to identify the specific elements associated with SES and maternal education that influence development in children.
Early Child Development and Care 126 (3): 111-19 (1996 Dec)
A Comparison of Vicarious and Written Training Techniques Applied to Early Stimulation by Parents of Their Down Syndrome Babies
Compared effectiveness of vicarious and written training techniques to teach parents an early stimulation program for infants with Downs Syndrome. Found that infants whose parents were trained through observing a clinician stimulate their child had higher average developmental quotients in gross motor and language development between 6 and 24 months than infants whose parents were trained using written materials.
Mental Retardations and Developmental Disabilities 2 (2): 96-101 (1996)
Effectiveness of Early Intervention for Children with Down Syndrome
Hines, Stefani; Bennett, Forrest
Center on Human Development and Disability, University of Washington, Seattle, Washington
This article reviews studies evaluating the effectiveness of early intervention for children with Down syndrome. Evaluation of early intervention programs is difficult and challenging, given the wide variety of experimental designs and the limitations of research studies. Overall, however, positive changes were seen in the development of children who were exposed to early intervention programs. Children with Down syndrome and their families are likely to benefit from early intervention.
Phys Ther 73 (3): 170-179 (1993 Mar)
Connolly BH, Morgan SB, Russell FF, Fulliton WL
BACKGROUND AND PURPOSE. The long-term motor, cognitive, and adaptive functioning of a sample of adolescents with Down syndrome who experienced an early intervention program was examined in this descriptive study. SUBJECTS. Ten children with Down syndrome (7 girls, 3 boys) who had participated in an early intervention program constituted the early intervention (EI) group. An age-matched group of children with Down syndrome (6 girls, 4 boys) who had not experienced an early intervention program served as a comparison group. METHODS. The EI group’s motor functioning was compared with that of a normative sample used in the development of the Bruininks-Oseretsky Test of Motor Proficiency. The cognitive and adaptive skills of the EI group were compared with those of the comparison group. The children were assessed using the Stanford-Binet Intelligence Scale, the Vineland Social Maturity Scale, and the Bruininks-Oseretsky Test of Motor Proficiency. RESULTS. The EI group subjects fell below their chronological age levels in gross and fine motor skills; however, their mean gross motor skill levels exceeded their mean fine motor skill levels. The specific deficits in gross motor and fine motor skills, which were documented in a previous follow-up study on the same sample, continued to be areas of deficits (visual motor coordination, running speed, balance, and reaction time). The EI group subjects had significantly higher scores on measures of intellectual and adaptive functioning than did the children in the comparison group. The EI group subjects did not show the decline typically seen with age in adaptive functioning in individuals with Down syndrome. CONCLUSION AND DISCUSSION. Because of the design limitations, the differences between the groups should be interpreted with caution.
Topics In Early Childhood Special Education 11 (1): 56-68 (1991 Spr)
Effective Early Intervention: Results from the Model Preschool Program for Children with Down Syndrome and Other Developmental Delays
Fewell, Rebecca R.; Oelwein, Patricia L.
Preschool children (n=194) with special needs enrolled in the Model Preschool Program for Children with Down Syndrome and Other Developmental Delays exhibited significantly higher rates of development during intervention than when the children entered the program. Effects were mixed for the 92 children with Down syndrome, with higher rates of development found only on some subtests
Exceptional Parent 19 (4): 48-51 (1989 May-Jun)
The Other Side of the Story
The mother of a seven-year-old boy with Down’s Syndrome describes her feelings as she came to realize that, despite intense early stimulation activities, her son’s developmental capabilities were limited. The article also notes that media exposure of the successes of some disabled children sometimes creates unrealistic expectations in parents.
Journal of Mental Deficiency Research 32: 1-17 (1988 Jan)
Aggregated early intervention effects for Down’s syndrome persons: patterning and longevity of benefits
Gibson D, Harris A
Department of Psychology, University of Calgary, Alberta, Canada.
Pooled findings from 21 early intervention demonstration studies for Down’s syndrome infants and children yield consistency of short-term benefits in the growth of finer motor skills, simple social repertoire and DQ/IQ scores, but conflicting evidence in support or not of benefits in the gross motor, linguistic and cognitive/academic domains. Support for the tenacity of gains, on follow-up to the early years of primary schooling, is disappointing. It is recommended that: (1) intervention programmers view the key working assumptions and ideological positions governing present practices more critically; (2) intervention curricula reflect the unique biological and behavioural properties of the syndrome, taking into account individual differences which are independent of etiological label; and (3) care delivery systems be based more fully on multidisciplinary collaboration, especially between the health sciences and education fields.
Physical & Occupational Therapy in Pediatrics 7 (1): 81-92 (1987 Spring)
Early Intervention for Infants with Down Syndrome: Efficacy Research
Naganuma, Gay M.
Child Development and Mental Retardation Center, University of Washington
In this annotated bibliography some of the major research projects recently conducted concerning the efficacy of early intervention with infants with Down syndrome are summarized. Many of the studies were confounded by extraneous variables so that clear conclusions about the relationship between early intervention and developmental progress cannot be made. Research is needed to identify therapeutic techniques and strategies appropriate for this population so that individuals involved in the care of an infant with Down syndrome will have objective guidelines for establishing intervention programs.
Phys Ther 10 (64): 1515-1519 (1984 Oct)
Evaluation of children with Down syndrome who participated in an early intervention program. Second follow-up study
Connolly BH, Morgan S, Russell FF
The long-term effects of an early intervention program (EIP) on the motor, cognitive, and adaptive functioning of children with Down syndrome were examined. The cognitive and adaptive functioning was compared with a group of children with Down syndrome who had not participated in an EIP. The motor functioning was compared with the normative sample used in the development of the Bruininks Oseretsky Test of Motor Proficiency. The children were assessed using the Stanford-Binet Intelligence Scale, the Vineland Social Maturity Scale, and either the Bruininks Oseretsky Test of Motor Proficiency or the Gesell Schedules of Motor Development. Results revealed that the children in the EIP earned significantly higher scores (p less than .0005, p less than .05) on the measures of intellectual and adaptive functioning than did the children of comparable age who did not participate in an EIP. The children in the EIP did not show the decline typically seen with age in intellectual and adaptive functioning in children with Down syndrome. The children in the EIP were below expected age levels in gross (77.7%) and fine motor skills (58.3%) but had mean fine motor skill levels that exceeded their mean gross motor skill levels (50%). Based on the results, EIPs for children with Down syndrome appear to provide a foundation for subsequent learning and development.
Phys Ther 60 (11): 1405-8 (1980 Nov)
Early intervention with Down syndrome children: follow-up report
Connolly B, Morgan S, Russell FF, Richardson B
This report compares developmental milestones and current intellectual and adaptive functioning of 20 children with Down syndrome who participated in an early intervention program with those of 53 noninstitutionalized children with Down syndrome who did not experience such a program. The children in the former group generally showed earlier acquisition of motor and self-help skills and significantly higher intelligence quotients and social quotients at three to six years of age. Because of certain variables that could not be rigorously controlled in this type of program, the higher functioning cannot be clearly attributed to early intervention. These findings nevertheless are consistent with the hypothesis that early intervention has a beneficial effect and should provide encouragement for further studies.
Phys Ther 56 (2): 155-158 (1976 Feb)
Interdisciplinary early intervention program
Connolly B, Russell F
Developmental data were obtained on 40 children with Down’s syndrome by an interdisciplinary team during an ongoing early intervention program. Interventive methods are described. Results are compared with available data on children with Down’s syndrome who were not in early intervention programs. Comparisons of developmental progress are also made of children begun in the early intervention program before six months of age with those begun after six months of age. Conclusions from the study indicate that early intervention helps the child in earlier attainment of many developmental tasks and enhances functioning of the family unit.