Early intervention can have a tremendous impact on your child’s development and set your child – and your family – on the right path. There are a lot of different therapies to consider, and bringing together all the right elements of a successful program can be challenging. How do you know what therapies are needed, how often they should happen, and who should deliver them to get the most progress?
Our goal is to share the knowledge that will empower you to make the best decisions for your child’s Early Intervention Program. The therapies in an Early Intervention Program are especially important because of the brain’s incredible plasticity during the first few years of life. The brain remains plastic throughout life, and harnessing the potential early on can make a lasting impact on your child’s future growth and development.
What is “early intervention?”
In the field of child development, the term “early intervention” refers to therapeutic services for infants and young children who have a delay in reaching developmental milestones. In the field of autism therapy, early intervention often refers more specifically to therapeutic services provided to children before starting kindergarten. These early intervention services may include sensorimotor and communication therapies, such as occupational, physical, music and speech-language therapy. They might also include Applied Behavioral Analysis (ABA) therapy or developmental and relationship-based therapies.
Another term that is commonly used in the field of autism therapy is Early Intensive Behavioral Intervention (EIBI). EIBI refers to therapy for young children with autism based on the principles of ABA. This type of intensive ABA-based therapy is usually delivered for 20 to 40 hours per week over multiple years. EIBI is one of the most well-established treatments for autism, and research indicates that its effectiveness is enhanced with strong parent participation. Data from our clinical experience suggests that EIBI – when delivered in an integrated way with other important therapies such as occupational, physical, music and speech-language therapy – leads to even greater results.
What are the benefits of early intervention?
Research studies have found that when a child with autism receives early intervention, there can be improvements in cognitive ability and language skills (both receptive and expressive language). Children can also show improvements in daily life skills such as using the bathroom, bathing, feeding and other functional activities.
In our experience working with thousands of children, we have seen improvements – sometimes dramatic – in all areas of child development, including behavior, communication, cognitive ability and social skills. We believe that these results are possible when an Early Intervention Program has five essential features:
1. Integrated Medical Care
One of the most unique aspects of Cortica’s approach to autism is that we include medical evaluation and treatment as a central piece of a child’s Early Intervention Program. Why? Because at the root of autism, or any developmental delay, are one or more causes. The first question we should ask when a child is diagnosed with autism is why?
This may sound simple enough, but many people make the mistake of saying that autism itself is a cause. Autism is a word that describes a set of differences in how a person communicates, socializes and behaves. There can be a variety of reasons for those differences. Specific medical tests, genetic information, metabolism, electrophysiology, neurochemistry, brain structure, gastrointestinal health and other biological characteristics allow us to target all therapies (medical and others) to a child’s unique neurobiological profile.
We believe that it’s time to change how our profession thinks about early intervention for autism. It’s time that medical testing and treatment – employing a diverse set of neurological, metabolic and holistic treatments – be considered an essential and ongoing piece of a full therapeutic program. We believe that an understanding of the child’s unique neurobiology should influence how other therapies are implemented. This analysis requires a high level of expertise and frequent collaboration between the medical provider and the entire multi-disciplinary therapy team.
2. Intensive Implementation
The word intensive, when applied to autism therapy, usually refers to the number of hours of therapy per week. In the field of ABA, 20 to 40 hours per week is often considered to be the criteria for an intensive program, but this doesn’t take into account the number of hours spent in other types of therapies and doesn’t specify the settings in which therapy should take place.
We believe that effective early intervention for autism requires an intensive program, but that the number of hours per week alone is only one factor to consider. In our view, a program is intensive if it covers multiple contexts in the child’s life (the more, the better), includes a high level of parent participation in as many settings as possible, and is cohesive, with common goals being shared by therapists across multiple disciplines who are communicating and collaborating on a recurring basis.
3. Comprehensive Center-Based Services
We recommend an intensive Early Intervention Program of four to six hours per day, five days per week, in a center-based program for most children with autism who are under the age of six. Additional hours of therapy should also be provided in the home or community to ensure that new skills are generalized to other settings.
A comprehensive center-based program should target sensorimotor, cognitive and language development through services such as occupational, physical, music t and speech-language therapy. The goals and strategies used in these therapies should be integrated into your child’s ABA program to achieve consistency and synergy across your child’s entire program.
Are school-based and center-based services different for pre-school children? At present, school-based and center-based services differ in many ways. School-based services focus on a set of goals related to academic skills. In this setting, school resources need to be carefully distributed across many students. Center-based services generally target a wider range of goals and emphasize building foundational skills to prepare a child for success in academic and other environments. Center-based evaluations aim to recommend an optimal number of service hours rather than the minimum acceptable.
4. Individual and Group Therapies
It’s important that children in Early Intervention Programs have the chance to participate in both individual and group therapies. Individual sessions provide the opportunity for a child to learn skills that are best-addressed one-on-one with an adult instructor. These skills are usually newly emerging and benefit from greater one-on-one support. Newly emerging skills can be more challenging for a child to demonstrate in group settings because of the additional demands that those settings bring. For example, group interactions require a child to process a greater variety of unpredictable stimuli from other children.
Group sessions, however, are equally as important as individual sessions because they offer opportunities for children to interact and build peer relationships. Some children may not yet be ready for group therapies at the outset of their Early Intervention Program, but a plan should be in place to incorporate group therapies as soon as the child is ready.
Opportunities for interactions with neurotypical peers – in the clinic, home or community – can also be a great addition to an Early Intervention Program.
5. Family Engagement
You might be surprised to know that one of the strongest – if not the strongest – finding from research studies is the association between the level of parent participation in early intervention and a child’s progress. At its core, early intervention is about empowering parents and other family members to be the primary agents of change in their child’s learning and development. The more you can learn from your child’s team of professionals and become skilled in providing learning opportunities for your child, the greater the progress you’ll see.
Can early intervention “reverse” autism?
Most professionals don’t think of autism as a condition that can be “reversed” or “cured.” And we don’t yet have treatments that can reverse or cure the underlying causes of autism. However, it’s important to keep in mind that there are some causes of autism (mainly metabolic or electrophysiological causes) that, if identified early, can be treated successfully. With effective treatment, a child’s development can improve dramatically. Though these conditions make up a minority of the causes of autism, it is essential to thoroughly evaluate for these causes as soon as a diagnosis of autism is made.
There are some children with mild symptoms who respond very well to intervention and, over time, may no longer meet the diagnostic criteria for autism. Rather than considering this a reversal or cure for autism, we think of it as a strengthening of skills and neural networks for communication, social interaction and other behaviors that can allow a child to excel in mainstream schooling and in building social relationships.
Where do I go from here?
Armed with knowledge about the essential features of a great Early Intervention Program, you’re well equipped to select the right services for your child. At Cortica, we’ve brought together all the components of a great Early Intervention Program to give your child and your family a jumpstart to a bright future!