Title: Early intervention strategies with babies and toddlers born prenatally cocaine exposed: areas of focus and hope
1Early intervention strategies with babies and
toddlers born prenatally cocaine exposed areas
of focus and hope
- Substance Exposed Newborns Collaborative
Approaches to a Complex Issue - June 23-24, 2010
- Lynne Katz, EDD
- University of Miami, Department of Psychology
2Background
- Children who are prenatally exposed to cocaine
are at-risk for cognitive, language, and
behavioral delays (Lester, et al., 2000) - Regardless of etiology, children who are
prenatally exposed to cocaine are an at-risk
population who are likely to benefit from early
intervention services.
3Background
- Most of the intervention research for
substance-exposed children has focused on the
impact of home-based programs (Black, et al.,
1994) - The University of Miamis Linda Ray Intervention
Program was designed to examine the impact of
three levels of intervention on developmental
outcomes for children who are prenatally exposed
to cocaine. Multiple cohorts of babies and
toddlers have participated since 1991 - There is an 80 overlap between these children
and the child welfare system
4Developmental screenings are mandated for child
welfare linked children
- Child Abuse Prevention and Treatment Act (P.L.
93-247) - Families are at the table when the Individual
Family Support Plan (0-3) and the Individual
Education Plan (36 months ) are developed as
part of the IDEA Part C and Part B entitlements - Opportunities to discuss the childs special
needs and to what degree the family embraces the
concept of special needs and services are the
first steps
5Focus of interventions What families and the
Court can expect
- The literature tells us the prevailing areas of
developmental delay continue to be related to
speech and language and social-emotional
development - We will be using science to inform our
interventions - Families will be engaged in the process of
intervention development from the start and
knowledge transfer will be ongoing
6Ages Stages Developmental Screenings in
Miami-Dade FL Children of Substance Abusing
Parents enrolled in Dependency Drug Court
- 200 screenings completed in 2007
- Children range from 04 months- 48 months
- 72-78 children showed delays as compared to the
10-30 expected w/in general population
7Comparison
- How did these children compare to a larger but
similar sample? - Linda Ray Intervention Center screened 200
infants toddlers to compare with the DDC Court
sample - Areas of delay in both groups primarily
social-emotional language development - Delays become more evident approaching 24 months
as impact of risk heightens during the expected
burst of language
8Cognitive Development Bailey MDI Scores
Linda Ray Infant Center Data as of 12-2-99, N329
9Impact on the child, the family and multiple
systems Getting the buy-in
- Research informed intervention offers best chance
for narrowing or ameliorating developmental
delays prior to child entering kindergarten - Opportunities to reduce the stressors related to
parenting a child with special needs when
intervention and parenting strategies are
available to families in one-stop shopping format
- Increases chances that child will be ready for
school - Makes economic sense across systems of care
10Target specific areas for intervention within the
domains
- Joint attention
- Gestures and early vocalizations
- Receptive and expressive language
- Early literacy exposure
11Families learn their role in creating language
outcomes and the role of the interventionist
- Research suggests that caregivers that use more
complex syntax, a richer vocabulary, and are
responsive and sensitive to their childrens
signals encourage the development of linguistic
capabilities. - These factors may be particularly influential for
children at-risk for developmental delays where
developmentally informed input at home may be
lacking.
12TechniquesEnhanced Milieu Training (EMT)
- EMT is intended for toddlers with a vocabulary of
greater than 10 words. - Relies on environmental arrangement, responsive
interaction, and milieu teaching procedures to
promote new language forms. - Verbal prompts, expansions of utterances, and
social consequences are used to increase language
use.
13 EMT Intervention
- Intervention procedure
- Establishing a turn-taking routine with the
child. - Interrupting the routine so requesting behavior
is a solution. - Resuming routine when requesting behavior is used
and verbally acknowledging/modeling the
appropriate form of the communicative behavior. - Behaviors and vocalizations become more complex
throughout the intervention sessions.
14Participants
- EMT study included
- children were identified as having the same
primary caregiver from 18 to 36 months (both in
home and at the Center) - this primary caregiver was the same caregiver who
participated in the 24-month interaction - N 89 caregiver-child dyads
- Data collected at 36 months using the Reynell
Developmental Language Scales
15Method (continued)
- At 24 months, the dyads participated in a
six-minute play interaction. - Interactions were coded for variables examining
caregiver speech, responsivity, and directiveness.
16Results
- Lexical richness and adult responsivity were
significantly associated with language outcome at
36 months. - Number of words and directiveness were not
significantly associated with language - Informs both discussions for the parenting
programs and the work of the interventionist
17Discussion
- Milieu training appears to be valuable to
enhancing the pre-linguistic and linguistic
abilities of substance-exposed children. - This intervention allows the interventionist to
work closely with the childs individual needs. - Children are enthusiastic about the naturalistic
interaction.
18Results (continued)
- Findings indicated that only lexical richness,
not directiveness, independently accounted for a
significant amount of the variance in language
outcome.
19Conclusions
- These results have critical implications for both
the understanding of language development in a
high-risk population, as well as the development
and implementation of interventions designed to
impact the language outcome of young at-risk
children.
20Priming to enhance language
- Priming is an acoustic intervention that
stimulates and exercises middle ear muscles when
the individual is in a calm state with the goal
of improving social engagement behaviors (e.g.,
listening and eye contact). - Previous research with the priming stimuli
demonstrated improved communication in children
with autism (S. Porges, University of Illinois at
Chicago).
21- Linda Ray Children participate in the listening
intervention for 40 minutes daily for 1 week. - Children listen to adapted Disney music via Mp3
players and headphones created for young
children. - After the initial 1 week intervention, children
listen to music for 10 minute boosters every day
for 15 weeks. - Embedded into practice when child turns 18 months
(pre-empting the 24 months dip)
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25Overall, our studies have shown that Priming is
effective in increasing the language and
cognitive ability of cocaine exposed children.
26Curriculum components
- Language development curriculums and
interventions i.e.Hanen Program Learning
Language and Loving It - Dependency System Process understanding
- Conscious Discipline (Bailey, 2005)
- Sensory Integration
- Attachment
- Parent-Child Relationship building
27Food for thought
- What does early intervention in your state
provide for the target group of babies and
toddlers born prenatally exposed? - For those children served, what does outcome data
on children leaving Part C look like? - What specific training components are offered to
early interventionists about SEN population? - Opportunities for cross-state collaborations
exist