Outcome of early intervention in infants at risk of developmental delay: a pilot study

Objectives To assess the outcome of a home based psychosocial intervention programme on facilitating development in infants at risk of developmental delay. Method Three groups of infants were involved. Group I comprised infants who suffered from adverse pregnancy and perinatal events and received psychosocial intervention. Group II comprised infants born during the same period with no similar risks and no intervention. Group III comprised infants who had adverse pregnancy and perinatal experiences but did not receive any intervention. Group 1 mothers were trained to carry out structured activities at home with the infant, adapted from the Portage Model. Outcome was measured at 12 months of age. The scores in 12 different skills in 5 developmental domains in the three sample groups were compared at the end of 12 months. Results Mean developmental scores in Groups (Gps) I (n=36), II (n=32) and III (n=9) were 10.00, 10.75 and 3.11 respectively. Independent sample t test showed no statistically significant difference in developmental scores at 12 months between Gps I and II (p=0.242, mean difference 0.750, 95% CI 2.019 to 0.519). Difference in developmental scores between Gps I & III was highly significant (p=0.000, mean difference 6.889, 95% CI 4.588 to 9.189). Conclusion Early intervention is effective and feasible in preventing developmental delay. ___________________________________________ 1 Professor of Psychological Medicine, Faculty of Medicine, Colombo. 2 Public Health Nursing Sister, MOH Division, Panadura (Received on 23 June 2006. Accepted on 20 July 2006). Introduction Prevalence of developmental disorders in children in non-industrialised countries is 12-29% 1 . Prevalence for Sri Lanka probably falls within this range, as indicated by population based studies. For example, a study, which assessed developmental readiness for school entry at 5 years of age, showed delayed cognitive development in 17.8%, leading them to being less ready to commence formal education 2 . Further, a study on mental health problems of urban preschool children identified delayed language development alone in 10% 3 . Many children with clinically identifiable developmental problems present late for medical help due to low rate of early recognition. For example, 34.5% of referrals to a specialist child mental health outpatient service were for developmental delay and learning disabilities, but the majority of referrals were over 5 years of age at the time of seeking help 4 . Though 49.9% of these children had delayed early motor and language milestones and 24.3% had suffered adverse birth and perinatal events, these negative prognostic indicators were not acted upon with earlier developmental interventions. In industrialized countries, community based intervention programmes for developmentally delayed children have been available for over three decades. These programmes are based on a range of biological, social-ecological and psychodynamic models. Irrespective of the cause of the developmental disorder, these intervention programmes are designed to improve skills, educational attainment and quality of life and prevent behavioural problems. A few such programmes are, the “Head Start” in the United States (US), “Sure Start” in the United Kingdom (UK) and “Portage Early Education Programme” in US and UK. Most programmes require high resource utilization and mainly target the infant and preschool age groups. Rationale for intervention commencing in infancy as opposed to preschool years is supported by recent advances in knowledge on neuro-biological processes associated with development. It has been shown that development of cognitive skills is related to significant structural changes in brain during perinatal period and first few months after birth. These changes include increase in brain weight and neuronal density, rapid dendritic arborisation and synaptogenesis and functional specialization 5,6 . Hence, the outcome of developmental intervention is optimal if applied in infancy as synaptic connections are unlikely to establish later. In addition, as the shaping of brain structures and strengthening of connections takes place, there is weakening and elimination of unused connections 7 . Therefore, psychosocial stimulation should be provided in infancy to obtain the best benefit. This approach is especially relevant for cognitive and language development, even though clinical evidence of developmental delay in these skills may not be apparent at this early stage. Considering the above mentioned evidence, this study examines the effectiveness and feasibility of using a psychosocial intervention programme in early infancy in those who are identified at birth with risk factors for later developmental delay.