This month’s post was written by guest writer, Dr. Plern Pratoommas, Early Intervention and Child Development Specialist.
Hello Expat Speechie fans!
The first half of this post will be a bit more informational and the second part are responses to some commonly asked questions that I get from parents.
What is Early Intervention?
Early Intervention is a broad term that refers to various therapy and education services for infants and toddlers who have delays or disabilities. Early Intervention can also be provided to children who are “at-risk” due to preterm birth or low birth weight.
Early Intervention is provided by different types of professionals from different fields. This is why you’ll sometimes hear the term “multidisciplinary” to describe Early Intervention services. Professionals on your child’s Early Intervention team may include: Occupational Therapists, Physical Therapists, Speech Therapists, Special Educators, and Developmental Therapists. However, there might be other medical or educational professionals that are involved in your child’s program. For a brief description about professionals who work with infants and toddlers with delays or disabilities, please see: https://www.understood.org/en/learning-attention-issues/treatments-approaches/early-intervention/at-a-glance-specialists-who-work-with-babies-and-toddlers
What is the purpose of Early Intervention?
The main purposes of Early Intervention is to:
1) support optimal development in children with special needs or delays, and
2) mitigate challenges or “secondary disabilities” that may develop later on because of the child’s disability.
Early Intervention is based on the assumption that children can adapt to their environment despite their challenges and condition. Therefore, it is important that the professionals who work with your child adopt this assumption as well and use a strengths-based approach in their work (focusing on the strengths and positives, not just the deficits).
Early intervention is still considered a relatively new and evolving field, even in countries like the United States. With recent research on brain development, we are learning more about the amazing capacity of infants to learn about the world even at birth. Early childhood is a period when brain development takes place at a rapid rate and is now known to be a critical time in human development. For this reason, Early Intervention has become more of a focus in recent years. The important point to remember about Early Intervention is this: The earlier we “intervene”, the less effort is needed to influence the brain’s ability to be shaped by experiences. So… intervening early is a good investment.
For more information on brain development in early childhood, please visit: https://developingchild.harvard.edu/science/key-concepts/brain-architecture/
What does Early Intervention look like?
Early Intervention might look different depending on where you live, since the system for children and family-related services is heavily shaped by social, cultural, and political factors. In some countries, such as Australia, Early Intervention services are publicly-funded and of no cost to families. In other countries, such as Thailand, parents may have to seek supports and services on their own from the private sector.
Early Intervention can follow different formats and take place in different settings, such as, child care programs, nursery school, preschool, direct intervention in the child’s home, therapy at community clinics or hospitals, parent coaching and training programs.
There are many variations to how Early Intervention is provided to families across countries. In my experience, Early Intervention is typically delivered in the family’s home or in other “natural settings” where other children (without disabilities) spend a lot of time such as, child care centers and preschools. Early Intervention sessions usually involve a specialist working with both the parent and the child on important developmental skills.
Highly-qualified professionals know a lot about typical child development, atypical child development, and ways to effectively support a child’s learning and development. A highly-qualified Early Intervention professional is knowledgeable and understands how children learn and they are effective in transferring this knowledge to parents.
Who benefits from Early Intervention?
For a child who is diagnosed with a disability, Early Intervention is important because the way in which the child learns best and the rate that they learn may require specialized knowledge, specific intervention strategies and specialized approaches. For example, children with Autism are most likely to benefit from programs that are comprehensive, intensive, and focused on key areas that are delayed in Autism (communication, play, and joint attention).
Specialized knowledge and intervention strategies are particularly important when the child’s parent or caregiver has limited information about their child’s diagnosis. Support from a qualified professional is required for the child’s optimal health and functioning.
Many Early Intervention programs and models in the United States, such as Routines-based Intervention (McWilliam, 2015), stress the critical role that Early Intervention professionals play in building capacity of parents and caregivers to embed learning opportunities into naturally-occurring daily routines to optimize child learning and development.
Although the end goal of Early Intervention is to promote optimal child development, parents and caregivers have become an essential part of the process and have therefore, become beneficiaries themselves.
For children whose development is “at risk”, Early Intervention is particularly important, given the vulnerability of brain development during the first few years of life.
Below are some common questions that a lot of parents have asked me:
What should I look for when seeking out Early Intervention services for my child?
Despite variations in service delivery, most experts agree that the core purpose of Early Intervention is to accomplish these goals:
1. To support you in your role as your child’s primary caregiver
2. To help you prioritize goals and learn effective strategies for interacting with and teaching your child
3. To support your child in his/her learning and development by teaching important developmental skills, promoting prosocial behavior, supporting emotional-social, motor, and cognitive development, motivating your child to learn and engage with the people around him/her
4. To minimize any additional challenges that may arise as a result of your child’s condition
5. To promote positive relationships (between you and your child and between the child and his/her interventionist)
If you do not feel like the professional you are working with is providing you with the tools to accomplish the objectives above, please talk to them about it. Alignment of expectations and goals is critical to the success of the intervention. Feel free to discuss this even before you start receiving services by being open and honest about what you are expecting from the professional you are working with. It may feel uncomfortable at first, but aligned expectations and goals will ensure a more successful intervention program for your child.
I have some ongoing concerns about my child’s development. Should I just wait and see how things turn out before doing anything?
The short answer to this question is no. Time is precious, especially in early development. Taking action earlier on does not mean that your child will end up being diagnosed with a disability. Sometimes, children are delayed in some areas but with enrichment activities to promote that specific area of development, they are able to catch up.
A lot of professionals ask me if they should mention anything to parents when they notice delays and my answer is always, YES! The conversation does not need to imply that something is “wrong” with the child. Given our understanding of the importance of early childhood, adults need to be responsible for supporting the child in any way they can to help them develop to their fullest potential.
What’s the danger in waiting?
If your concerns are minor (e.g. you wonder if your child is crying more than usual, or you notice that your child is not reaching yet), there may be no imminent danger in waiting a little while. However, there are certain “red flags” that are cause for more concern and you should explore these concerns NOW.
Although all children reach developmental milestones at different ages, there are general trends (an expected sequence) that is common in early development and should be monitored. For example, if your child is six months old and (1) is not lifting his head up when on his stomach, (2) moving his body in a more coordinated way, or (3) looking at you, smiling, or interacting in the way that other babies are, then you should seek out advice from a specialist as soon as possible. Or, if your child is two years old and has not spoken a single word yet, see a specialist as soon as possible. When you bring these concerns up to others, some people might tell you, “oh, your brother/sister also spoke late, don’t worry”, or “he’ll grow out of it”, but if you feel in your gut that something is not right, trust your gut. A parent’s intuition is usually right.
There are many early screening tools that are available to help you figure out for sure whether your child’s behaviors are delayed or developing normally. Here are some useful resources:
If you have some concerns about Autism, you can complete a screening for your child yourself at:
An important principle in child development is that children learn through repeated interactions, over time. The benefit about taking action earlier is that you have more time to influence your child’s learning and development. As the brain develops in early childhood, there is something that happens to brain cells called, “synaptic pruning”, whereby whatever unused networks in the child’s brain will prune away to make room for other networks that are more frequently used. When we have concerns about a child but choose to wait, we miss out on opportunities to positively influence a child’s development.
Where do I start?
A good place to start would be to arrange a Developmental Assessment for your child. This can be done by a Clinical Psychologist, Child Developmental Specialist or a Multidisciplinary Team. The outcomes of the Assessment will provide a picture of where your child is at in different developmental areas (communication, motor-skills, etc.). These findings will be used to identify potential goal areas for your child’s Early Intervention program. If you cannot find a Clinical Psychologist, Child Development Specialist or multidisciplinary team, you can ask your child’s Pediatrician or other medical professionals.
In Thailand, it is common for services for children with disabilities to be provided by the medical field. However, it is important for parents to know that accessing services at hospitals is NOT your only option. There are many public institutions that provide Early Intervention services, as well as providers in the private sector. You may want to contact organizations like the Rainbow Room (https://www.facebook.com/specialrainbow/) to inquire about service providers in your area. Do some research, go out and visit as many places as possible, speak to as many professionals as you can, seek out consultation and advice from professionals, and have conversations with your family about what you want for your child. Services should align with what your goals and priorities for your family are.
What if no one believes me?
Find someone who does! Continue reaching out and connecting with as many people as you can. You will find someone. Emotional support is one of the most important things.
This article was written by guest writer, Dr. Plern Pratoommas
Early Intervention & Child Development Specialist
ESDM Certified Therapist
I hope you found this article as helpful and informative as I did!
The Expat Speechie
Bruder, M. B. (2010). Early childhood intervention: A promise to children and families for their future. Exceptional Children, 76(3), 339-355).
Center on the Developing Child at Harvard University. (2016). From best practices to breakthrough impacts: A science-based approach to building a more promising future for young children and families. Retrieved from http://developingchild.harvard.edu/resources/from-best-practices-to-breakthrough-impacts/
Gray, R. & McCormick, M. C. (2005). Early childhood intervention programs in the US: Recent advances and future recommendations. The Journal of Primary Prevention, 26(3), 259-278.
Guralnick, M. J. (2001). A developmental systems model for early intervention. Infants and Young Children, 14(2), 1-18.
Guralnick, M. J., & Albertini, G. (2006). Early intervention in an international perspective. Journal of Policy and Practice in Intellectual Disabilities, 3(1), 1-2.
McWilliam, R. A. (2015). Future of early intervention with infants and toddlers for whom typical experiences are not effective. Remedial and Special Education, 36(1), 33-38. doi:10.1177/0741932514554105
Meisels, S. J., & Shonkoff, J. P. (2000). Early childhood intervention: A continuing evolution. In J. P. Shonkoff, & S. J. Meisels (Eds.), Handbook of early childhood intervention (2nd ed.) (pp. 3-31). New York, NY: Cambridge University.
Ramey, C. T., & Ramey, S. L. (1998). Early intervention and early experience. American Psychologist, 53(2), 109-120.
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