Early Intervention

Developmental differences in infants may be the first indicators for AD/HD; therefore, it is important to be aware of the following guidelines:

Infants whose performance is significantly below average in a given area or skill should be monitored.

Developmental milestones occurring out of sequence should alert carers to the possibility that problems may exist.

Examples:

An infant who crawls before sitting.

An infant with early development of hand preference.

An infant who does not crawl at all or crawls in an unusual way.

Research today shows that it is possible to identify AD/HD symptoms in pre-school age children. Typical warning signs include:

  • Jumping from activity to activity without finishing the previous one;
  • Finding it difficult to sit still (fidget, run around, etc.)
  • Forgetting their belongings (caps, coats, bags, etc.)
  • Having trouble fitting in with their peers
  • Being immature and often aggressive as a result
  • Being often excluded from early education programmes as a result

Why Does Early Intervention Work?

Behaviour therapy works best when it is started early in a child’s life because younger children have simpler problems and these may be responsive to behaviour and/or other evidence-based therapies.

Parent-child interactions are not yet ingrained in young children and so are easier to change. Besides, the longer a parent interacts negatively with a child, the greater the chances the child will develop secondary behaviours.The less-differentiated brain of younger child is more amenable to intervention because of its elasticity.

Research shows that Early Intervention results in lower rates of, and less severe, morbidities. As a result, the child’s self-esteem remains intact, family dysfunction is reduced and the prognosis for school is much brighter.

There is a body of research supporting the effectiveness of Early Intervention.

  • Is Early Intervention Effective in Preventing AD/HD?

    Rappaport, G.C., Ornoy, A., & Tenenbaum, A. (1998). Is early intervention effective in preventing AD/HD? In: Israeli Journal of Psychiatry and Related Science, 35, 271-27:

    The authors of this study noted that AD/HD is usually not diagnosed until after a child begins school, even though evidence of AD/HD symptoms is often present at a much earlier age. They found in prior work that among 2-4 year-old children who showed signs of inattention, hyperactivity and speech delay, approximately 80% were diagnosed as having AD/HD upon reaching school age.

    When looking at children according to whether or not there was a family history of AD/HD, the results are significant.

    Every child who was from a family where another member had AD/HD and who did not receive the intervention, was diagnosed with AD/HD at follow up.

    In contrast, only 37% of children who had the same family history but who received the early intervention developed AD/HD.

    These results suggest that, for children who are showing early signs of AD/HD and who have a family member who has this disorder, early intervention may be effective in reducing the odds of their developing AD/HD later on.

    Waiting until these children "outgrow" their symptoms, or not providing any assistance because they are too young to diagnose with AD/HD, does not seem like a particularly helpful position to take.

  • The Effects of a Positive Reinforcement and Response-Cost Intervention on the Disruptive Behaviour of Preschool Age Children with AD/HD

    McGoey, L. & DuPaul, G., 2000: The Effects of a Positive Reinforcement and Response-Cost Intervention on the Disruptive Behavior of Preschool Age Children with AD/HD. Journal of Emotional & Behavioural Disorders, Spring 2002, Vol. 10, No. 1.

    Teachers were taught to reward appropriate behaviours by awarding buttons on a chart and to discourage inappropriate behaviours by removing buttons.

    Children earned rewards at the end of each day based on the number of buttons on the chart.

    Direct observations of behaviour indicated decreases in disruptive behaviour during both interventions.

    Strengths of this study include detailed methodology, use of acceptability measures for teachers, report of treatment integrity data and use of school-based procedures.

    This study shows how effective Early Interventions can be when implemented in an inclusive preschool setting.

  • Multisetting Assessment-Based Intervention for Young Children At-Risk for Attention-Deficit/Hyperactivity Disorder: Initial Effects on Academic and Behavioural Functioning

    Kern L, DePaul G, Volpe R, Sokol N, Lutz G, Arbolino L, Pipan M, VanBrakle J. Multisetting assessment-based intervention for young children at risk for attention deficit hyperactivity disorder: Initial effects on academic and behavioral functioning. School Psychology Review, 2002; 36(2): 237-255.
    In this study, the researchers compared a multicomponent intervention (MCI) with a parent education (PE) program using a group of 135 preschoolers (ages 3 to 5) diagnosed with AD/HD and their parents.

    Results:

    Parent education, no matter how it was administered, proved very effective in reducing behavioural problems in at-risk pre-school age children in this study. The results indicate that behavioral interventions for preschoolers with AD/HD can be effective, and further study will help identify the best approaches.

  • Improving the Effectiveness of Behavioural Classroom Interventions for AD/HD

    Improving the Effectiveness of Behavioural Classroom Interventions for AD/HD : A Case Study. (2003). Fabiano, G. & Pelham, W.E.

    An 8 year-old boy called John who was diagnosed with AD/HD exhibited disruptive behaviour in class, which resulted in educational and social impairment.

    Researchers first used a behavioural programme already in use for this classroom at first, but had to modify it in ways that increased its effectiveness for children with AD/HD.

    John was allowed the opportunity to earn daily rewards based on his classroom behaviour.

    Teachers were asked to provide immediate feedback to John when he violated classroom rules.

    The behaviour criteria on John’s goal sheet were operationalized as fewer than 3 violations of each classroom rule.

    These relatively minor modifications resulted in such an improvement that his behaviour improved to within the normative range of functioning.

    Results:

    These results were achieved by increasing the intensity of the behaviour modification programme and John’s behaviour was normalized relative to classroom peers without stimulant medication.

    The study results suggest that an evaluation of the integrity of the existing classroom interventions is essential to individualize them for students with AD/HD.

  • An Evaluation of the Effectiveness of Early Intervention Techniques in Helping Children Decrease Defiant Behaviour and Aggression, while Improving Academic and Social Skills

    Project Achieve: 5 year study, most ambitious of its kind, identifies effective strategies for decreasing aggressiveness and improving behaviour.

    The study, led by George DuPaul, Professor of School Psychology at Lehigh; and Dr. John Van Brakle, Chair of the Pediatrics Department at Lehigh Valley Hospital, studied 135 preschool students with ADHD symptoms. (2007)

    The researchers evaluated the effectiveness of early intervention techniques in helping children decrease defiant behavior and aggression, while improving academic and social skills.

    The results were significant on every level:

    Using a variety of Early Intervention strategies, parents reported, on average, a 17% decrease in aggression and a 21% improvement in their children’s social skills.

    Teachers saw similarly strong results; in the classroom, there was a 28% improvement in both categories.

    Early literacy skills improved up to three times over their baseline status.
    Neuroscientists at the University of Oregon studied children aged 18-21 months old who had a gene called the “7 Repeat Allele” which has been associated with AD/HD.

    The researchers observed the children’s behaviour and their interactions with their parents.

    They found that children whose parents scored highest in measures of “parenting effectiveness” were less likely to show symptoms of AD/HD than children with the gene whose parents scored lower.

    The benefits a child receives from behavioural treatment are strongly influenced by the ability of the parent to consistently implement the program plan. (Thomas Brown, Ph.D. Yale University)

  • Early Intervention for Preschool-Age Children with AD/HD

    McGoey, Kara E., Eckert, Tanya L. and DuPaul, George J. Early Intervention for Preschool-Age Children with AD/HD: A Literature Review in: Journal of Emotional and Behavioural Disorders (2002).

    The researchers argue that children with AD/HD are often described as careless, disorganized, carefree and non-reflective even as the pre-school age and that in many cases the behaviour exhibited by these young children warrants their being excluded, which has a detrimental effect on their development. It is in the preschool setting that a child learns the social skills that are so valuable for him/her as a child in Kindergarten and beyond, not to mention the opportunity to get accustomed to being in a school situation.

    Without Early Intervention in school at and at home, many of the behavioural symptoms continue to appear and often escalate in Primary school when more demands are made on them. Those children who are interactive in preschool usually continue to be hyperactive in Primary school and beyond.

    The researchers reviewed the literature of studies, which met their predetermined selection criteria: all studies needed to examine the effects of interventions for preschool-age children with AD/HD. Further selection criteria were :

    Participants were preschool age children between the aes of 3 years, 0 months and 5 years, 11 months who were not attending a kindergarten programme.

    An intervention was implemented to address a problem behaviour associated with AD/HD.

    The methods and results were discussed in the article.

    Participants had not been diagnosed as having mental retardation or neurodeveloopmental disorders.

    The literature search and selection procedures identified 28 studies published between 1967 and 2000. The type of intervention the studies investigated broke down as follows:

    • psychotropic medication (n/14)
    • school-based behaviour management interventions (n/9)
    • parent-education programmes (n/4)
    • multicompomnent treatment approach (n/1)

    Results (link)

    Medication may address the symptoms of AD/HD, but it does not necessarily improve children’s academic and social skills.

    Because AD/HD is a lifelong disorder, without any cure, it is important that we start understanding what tools and strategies are effective for children with AD/HD at such an early age.

    Project Achieve shows us that offering more traditional services to at-risk children and more intensive services to children in greatest need, may be the most practical and cost-effective strategy for helping preschoolers overcome behavioural and academic challenges.

    It is important to address behavioral and academic issues before they become more problematic in elementary school.(Prof. DePaul)

    Project Achieve suggests that with careful assessment, such children can be accurately identified and that appropriate behavioral interventions are an important part of the treatment plan.

    The ramifications of disruptive behavior and possible removal from a preschool setting have strong implications for a child when s/he moves to elementary school. (Tara McGoey et. Al. 2002)

    Diagnosing disorders such as AD/HD early in the child’s life is essential.Untreated AD/HD, as well as other disorders, is often associated with likely higher rates of substance use, conduct problems and delinquency,Untreated AD/HD is often associated with school failure, and other adverse long-term outcomes.

    Behavioural therapies and certain medications can help.

    Parent Training* and Education Programmes for AD/HD both for pre-school and school-age children.

    Teacher's also need specific training to recognize and help children with AD/HD.

    Drugs (Ritalin, etc.) should be avoided for the under 5s; instead behaviour therapy should be used.

    Drugs remain a first option for children over five and young people with severe AD/HD, but only as part of a comprehensive treatment plan.

    Mandatory AD/HD training for Early Education and Pre-school programme leaders

    Mandatory AD/HD training to teachers, SEN leaders and school psychologists, etc. so that they fully understand the condition in all its forms.

    Mandatory Parent Training for all parents of children considered “at risk” of developing AD/HD and for all parents who have AD/HD in their own families.

    Mandatory checklists to screen for AD/HD upon entering preschool, kindergarten, and primary and secondary schools.

    Fabiano, G. & Pelham, W.: Improving the Effectiveness of Behavioural Classroom Interventions for AD/HD Disorder: A Case Study. Journal of Emotional & Behavioural Disorders, Summer 2003, Vol. II, No. 2, pages 122-128.

    Flynn McCarthy, L. (2008): Behavior Therapy for ADHD Children: More Carrot, Less Stick. ADDitude Magazine, Summer 2008 issue.

    Children with AD/HD: A Literature Review. Journal of Emotional & Behavioural Disorders, Spring 2002, Vol. 10, No. 1, pages 14-28.

    McGoey, L. & DuPaul, G., 2000: The Effects of a Positive Reinforcement and Response-Cost Intervention on the Disruptive Behavior of Preschool Age Children with AD/HD. Journal of Emotional & Behavioural Disorders, Spring 2002, Vol. 10, No. 1

    Green Paper for Mental Health Strategy in the EU; European Commission. 2006: http:// ec.europa.eu/health

    Kern L, DePaul G, Volpe R, Sokol N, Lutz G, Arbolino L, Pipan M, VanBrakle J. Multisetting assessment-based intervention for young children at risk for attention deficit hyperactivity disorder: Initial effects on academic and behavioral functioning. School Psychology Review, 2007; 36(2): 237-255.National Institute for Health and Clinical Excellence (NICE) (Guidelines September 2008): nice.org.uk/guidelines/CG72/doc./eng.

    Rappaport, G.C., Ornoy, A., & Tenenbaum, A. (1998). Is Early Intervention Effective in Preventing AD/HD? Israeli Journal of Psychiatry and Related Science, 35, 271-279;


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