Transcript Change in cognitive function over time in very low

Intervention
Daniel Messinger
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Intervention questions
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Describe the results of the Linda Ray
intervention. Describe the IHDP project and
its major results at 3, 5, and 8 years. What is
the animal model for early intervention?
Describe the major results of the Abecedarian
project. How do these results relate to those
of the rat study? Argue for whether you think
early intervention works, how long it works,
and for whom it works? Should society
devote resources to early intervention or later
intervention? What did Yoder and Stone find?
Explain how this isMessinger
a moderated effect. What
Early Head Start Effects
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The Effects of Universal Pre-K on
Cognitive Development
Gormley Jr., Gayer, Phillips, & Dawson
Developmental Psychology
2005, Vol. 41, No. 6, 872–884
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Linda Ray Intervention Center:
3 levels of intervention
Claussen, A. H., Scott, K. G., Mundy, P. C., &
Lynne F. Katz. (2004). Effects of three levels
of early intervention services on children
prenatally exposed to cocaine. Journal of
Early Intervention, 26(3), 204-220.
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Moderate to large intervention
effects Center Advantage
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Where should intervention take
place?
Effect Sizes
Center vs.
Home
Center vs.
Primary
Home vs.
Primary
Bayley MDI
.28
.73
.42
Receptive
.53
.62
.13
Expressive
.82
.92
.06
Gross Motor
.23
.82
.51
Fine Motor
.12
.09
.04
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It’s an ongoing problem
• 1.5 million children in Central and
Eastern Europe live in public care.
– Children who have been abandoned, parents have
died, live in hospitals because of a chronic illness
• Quality of care can be poor in these institutions
– Exceed 15:1 ration
– Poorly trained caregivers who are
uncommitted to the child’s welfare
(insensitive, unresponsive)
– Exposure to mature language is lacking.
– Basic sensory deprivation lacking
(not held or or touched)
– Strict adherence to conformity
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Effects on Development
• Adopted children did better across domains than
institutionalized children.
• Children who spent more than 8 months in Romanian
institutions had more behavior problems, disturbances of
attachment, and lower IQs.
• Bucharest Early Intervention Project (BEIP):
-3 cohorts
-Findings:
-Institutional care has negative effect on physical
growth, language, cognitive, social-emotional
development, and brain development.
-Children placed in foster care improved in many
of the domains .
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Effects on Brain Development
• Adopted children from institutions suffered from mild
neurocognitive impairments, impulsivity, attention, and social
deficits.
• Institutionalized children had fewer white matter connectivity
leading to less connectivity between brain regions.
• Normal range of IQ (although verbal IQ was lower than
performance IQ) in institutionalized children.
• Less cortical brain activity in institutionalized
children compared to never institutionalized
children.
• Institutions are low on environment-expectant
environment which is necessary for brain
development.
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Valid conclusion?
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“It is in contrast to severe deprivation
that enrichment shows its statistically
significant effects.”
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Gottlieb & Blair, 2004
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Gottlieb & Blair 2004
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Rodent research indicates that enriched
early experiences avert the deterioration of
learning ability seen when rodents are
reared in impoverished conditions
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It is only in comparison to impoverished
conditions that enrichment shows an influence
Exposure to enriched conditions after
exposure to impoverished conditions does
not matter
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Early visual experience &
exploration!
From about 27 days of age to 100 days of age:
(1) a stovepipe cage (little motor or visual experience),
(2) an enclosed running wheel (motor activity but little variation in visual experience),
(3) a mesh cage that restricted motor activity but considerable variation in visual experience as it was moved
daily to different locations in the laboratory.
(4) large free environment box – socially and physically stimulating
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Its early experience that’s
important
Table 2. Mean Errors in Hebb-Williams Maze of Rats With
Different Early and Late Environmental Experiences
Free
environment/
Stovepipe
161
Stovepipe/
Free
environment
Free
environment/
Free
environment
248
152
Normal Cage/
Normal Cage
221
Note. Data from Hymovitch (1952). The Stovepipe/Free Environment and Normal Cage groups
made significant more errors than the other two groups (p <.001).
Bell
Abecedarian project:
2 intervention components
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Birth – 5 years: “comprehensive educational
daycare intervention”
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“utilized developmentally appropriate curricula
designed to facilitate children’s language, motor,
social, and cognitive growth.
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Full-day care, 50-weeks per year, 93% enrolled by 3
months
5 – 8: “school age intervention delivered
through home visitors, liaisons between
home and school.
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designed to increase parent involvement in the
educational process
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Yield 4 intervention conditions
1.
2.
3.
4.
Early daycare intervention (birth – 5)
with follow through services to 8 years
Only the educational daycare
intervention
Only the school age follow through
An untreated control group.
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Early intervention counts!
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Real life: % retained in grade
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IHDP
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3-year intervention:
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home visits, child development center services,
parent group meetings.
Randomized controlled trial of premature infants
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(< or = 37 weeks' gestation): 2 LBW groups (lighter [<
or = 2000 g] and heavier [2001-2500 g])
intervention (n=377) and follow-up only (n=608).
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McCarton, C. M., Brooks-Gunn, J., et al. (1997). Results at age 8 years of early
intervention for low-birth-weight premature infants. The Infant Health and
Development Program. JAMA, 277(2), 126-232.
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3 Year effects
Behavioral Competence
Control Group Intervention Group
(n = 547)
(n = 338)
Mean (SD)
Mean (SD)
Child behavior
checklist
(age 2-3 y)
47.2 (20.5)
43.7 (19.1)
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Effect Size
(P)
18 (.006)
Age 3 effects visible only in
heavier group at age 8
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At 8 years, in the entire cohort and in the lighter
LBW, groups were similar on all outcome measures.
Differences favoring the intervention group
were found within the heavier LBW group:
full-scale IQ score (4.4 points, P=.007), verbal IQ
score (4.2 points, P=.01), performance IQ score
(3.9 points, P=.02), mathematics achievement
score (4.8 points, P=.04), and receptive
vocabulary score (6.7 points, P=.001).
But ‘attenuation of the large favorable effects seen at
3 years was observed in both the heavier and lighter
LBW groups.’
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Dose-response effects
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At age 8, effects on the Wechsler Intelligence
Scale for Children Full and Verbal scales for
children who attended > 400 days ranged
from 7 to 10 points.
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Heavier LBW infants (2,001–2,500 g), 14 points
lighter LBW infants (< 2,000 g), 8 points.
These effects were all substantially higher than
corresponding Intent-to-Treat effects.
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Similar, smaller effects for children attending 350 days.
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Hill, J. L., Brooks-Gunn, J., & Waldfogel, J. (2003). Sustained Effects
of High Participation in an Early Intervention for Low-Birth-Weight
Premature Infants. Developmental Psychology, 39(4), 730–744.
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Days of Treatment
Hill, J. L., Brooks-Gunn, J., & Waldfogel, J. (2003). Sustained Effects of High Participation in an Early
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Intervention for Low-Birth-Weight Premature Infants. Developmental Psychology, 39(4), 730–744.
18 Year effects!
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INTERVENTION group effects on math
(Woodcock-Johnson Tests of Achievement 5.1
points), risky behaviors (YRBSS, –0.7 points),
and vocabulary (PPVT-III, 3.8 points) in the
HLBW youth.
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Results adjusted for cohort attrition. Assessed 636 youths
at 18 years (64.6% of the 985, 72% of whom had not died
or refused at prior assessments).
Why no observable benefit in the LLBW
group?
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McCormick, Marie C., Brooks-Gunn, Jeanne, Buka, Stephen L., Goldman, Julie, Yu, Jennifer, Salganik, Mikhail, Scott, David T., Bennett,
Forrest C., Kay, Libby L., Bernbaum, Judy C., Bauer, Charles R., Martin, Camilia, Woods, Elizabeth R., Martin, Anne, Casey, Patrick H. Early
Intervention in Low Birth Weight Premature Infants: Results at 18 Years of Age for the Infant Health and Development Program
Pediatrics 2006 117: 771-780 (doi:10.1542/peds.2005-1316)
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Argument
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IHDP failed to produce any enduring
and meaningful effect on cognitive
development?
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2 primary reasons for this unsuccessful
outcome are failures to consider genetic
influences and to individualize
intervention
Early generic educational intervention has no enduring effect on intelligence and
does not prevent mental retardation: IHDP. Baumeister & Bacharach (2000).
Intelligence, 28(3), 161-192.
What is the take home message?
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Does intervention work?
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Did IHDP work?
Does inoculation model work?
What kind of intervention works?
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Effects for some
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Change in cognitive function over time in very
low-birth-weight infants
 Early intervention led to greater increases
over time in PPVT-R scores among children
whose mothers had less than a high school
education compared with those with a high
school education level or greater
(interaction).
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WHY?
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(Ment et al, 2003, JAMA, 289, 705-711)
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Randomized Comparison of Two
Communication Interventions for
Preschoolers With Autism Spectrum Disorders
Responsive Education and Prelinguistic Milieu Teaching [RPMT]
VS.
Picture Exchange Communication System [PECS]
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Each: 3 times per week, in 20-min sessions, for 6 months.
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RPMT facilitated the frequency of generalized turn taking and
generalized initiating joint attention more than did the PECS.
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But only for children who began treatment with some initiating joint
attention.
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36 preschoolers with autism spectrum disorders.
PECS facilitated generalized requests more than the RPMT in children with very
little initiating joint attention prior to treatment.
Effect sizes were large.
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Paul Yoder and Wendy L. Stone. Journal of Consulting and Clinical Psychology 2006, Vol. 74, No. 3, 426–435
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Results
•
•
•
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Initiating joint attention grew in both treatements
RPMT superior to PECS
PECS superior to the RPMT
Interactions
Strengths
•
•
•
Random assignment
High fidelity
Ecologically valid measures
Fernanandez
Overall Change in Frequency of
Intentional Communication Acts
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Pretreatment x Type of treatment
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ASD Interventions
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Landa et al.
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http://www.webmd.com/brain/autism/new
s/20101207/early-intervention-improvesautism-symptoms\
Denver Early Start
Carter et. al
A Systematic Review of Early
Intensive Intervention for Autism
Spectrum Disorders
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Child Effects
Randomized,
Controlled Trial
of an
Intervention for
Toddlers With
Autism: The
Early Start
Denver Model.
Dawson,
Rogers, et al.,
2009
www.psy.miami.edu/faculty/dmes
singer
Rogers
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JACAAP
No child effects for
ESDM with parent as
interventionist
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A Randomized
Clinical Trial of
Hanen’s More Than Words
Alice S. Carter
University of Massachusetts Boston
Wendy Stone & Paul Yoder
Vanderbilt University
Daniel Messinger
University of Miami
Intervention effects for low
functioning children with ASD
0.8
1.5
1
0.5
0
Control Group
-0.5
Treatment Group
-1
-1.5
Residualized Gain Scores of
Initiating Behavioral Requests
Residualized Gain Scores of
Initiating Joint Attention
2
3.15
5.51
Lower RoS Higher RoS
-2
0.6
0.4
0.2
0
-0.4
-0.6
2.85
5.10
Lower RoS Higher RoS
1.00
8.00
1.00
8.00
Min
Max
Min
Max
DPA Number of Toys at T1
6
4
2
0
Control Group
Treatment Group
-2
-4
2.50
Lower RoS
4.64
Higher RoS
1.00
8.00
Min
Max
DPA Number of Toys at T1
Residualized Gain Scores of
PIACV Nonverbal Communication
8
Residualized Gain Scores of
PCFP Weighted Frequency of
Intentional Communication
Treatment Group
-0.2
DPA Number of Toys at T1
-6
Control Group
0.8
0.6
0.4
0.2
0
Control Group
-0.2
Treatment Group
-0.4
-0.6
-0.8
5.51
Higher RoS
1.00
8.00
www.psy.miami.edu/faculty/dmes
Min
Max
DPA Number of Toys at T1
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Parenting Effects?
[email protected]
Additional readings
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Messinger, D., Dolcourt, J., King, J., Bodnar, A., & Beck, D. (1996). The survival and
developmental outcome of extremely low birthweight infants. Infant Mental Health Journal,
17(4), 375-385.
Hollomon, H.A. Dobbins, D. R., & Skott, K.G. (1998). The effects of biological and social risk
factors on special education placement: Birth weight and maternal education as an
example. Research in Developmental Disabilities, 19(3), 281-294.
Infant Health and Development Project (1990). Enhancing the outcomes of low-birthweight, premature infants: A multisite, randomized trial. Journal of the American Medical
Association, 263(22), 3035-3042.
Brooks-Gunn, J., McCarton, C., McCormick, M. C., & Klebanov, P. K. (1998). The
contribution of neighborhood and family income to developmental test scores over the first
three years of life. Child Development, 69(5), 1420-1436.
Vohr, B. R., Wright, L. L., Dusick, A. M., Mele, L., Verter, J., Steichen, J. J., Simon, N. P.,
Wilson, D. C., Broyles, S., Bauer, C. R., Delaney-Black, V., Yolton, K. A., Fleisher, B. E.,
Papile, L.-A., & Kaplan, M. D. (2000). Neurodevelopmental and Functional Outcomes of
Extremely Low Birth Weight Infants in the National Institute of Child Health and Human
Development Neonatal Research Network, 1993-1994. Pediatrics, 105(6), 1216-1226.
Susan Landry, Developmental Psychology.
Zeanah, C. on developmental risk. J am acad child and adol psychiatry '97 362.
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